. Röntgen ray diagnosis and therapy . Pig. 105.—Patellar Fragments turned after Wiring. graph has revealed the presence of multiple fractures. It is true,that if the injury is examined just after the fracture occurred,crepitus is generally produced, but afterward the intervention ofblood-clots between the fragments prevents its production. If the periosteal coat of the patella remained intact there is nodisplacement, and consequently no crepitus. The same rule ap-plies to fracture of a small portion of the patella. It is evident that in case of extreme extravasation, when, forinstance, the pre
. Röntgen ray diagnosis and therapy . Pig. 105.—Patellar Fragments turned after Wiring. graph has revealed the presence of multiple fractures. It is true,that if the injury is examined just after the fracture occurred,crepitus is generally produced, but afterward the intervention ofblood-clots between the fragments prevents its production. If the periosteal coat of the patella remained intact there is nodisplacement, and consequently no crepitus. The same rule ap-plies to fracture of a small portion of the patella. It is evident that in case of extreme extravasation, when, forinstance, the prepatellar bursse are distended by coagula, palpa-tion of the fragments becomes so difficult that the injury may betaken for contusion of the knee-joint. 156 THE KONTGEN EAYS With few exceptions union in transverse fracture of the pa-tella, if not sutured, fails to become osseous, fibrous bands fillingup the gap between the fragments. In such an event the function. Fig. 106.—Diastasis op Patellar Fragments Twenty Years after the Injury. of the joint is impaired—inability to perform extension andthorough flexion, considerable atrophy of the muscles and greateror lesser degree of knock-knee being the predominating those patients who follow a light occupation may not beincapacitated and can carry their burden with the aid of a knee-cap, working men are deprived of their means of making a livingby not possessing the use of their limb. This shows how impor-tant it is, when the question of an operation turns up, to have anexact anatomic representation of the area involved—in otherwords, a good skiagraph. PELVIS AND LOWER EXTREMITY 157 Whether an indentated plaster-of-Paris dressing will in casesof little or no diastasis suffice to bold the fragments together,will best be determined on the basis of a skiagraph. And, fur-thermore, whether this mode of immobilization was successful inkeeping the fragments in apposition will be ascert
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