. Manual of operative surgery. d to the articular surface of the fractured fragment of bone may become wedged into the knee-joint(Fig. 1123). Operative Treatment.—5/e/> i.—Freely expose the site of injury by a ver-tical or, better, by a horseshoe-shaped incision having its base above. If theknee-joint is involved, wash all blood-clots, etc., out of it. Step 2.—Reduce the fracture. To do this satisfactorily it may be necessaryto pass a strong suture transversely through the tendo patellae as a tractor. * For a full discussion of the accident and its treatment see Gaudier and Bouret,
. Manual of operative surgery. d to the articular surface of the fractured fragment of bone may become wedged into the knee-joint(Fig. 1123). Operative Treatment.—5/e/> i.—Freely expose the site of injury by a ver-tical or, better, by a horseshoe-shaped incision having its base above. If theknee-joint is involved, wash all blood-clots, etc., out of it. Step 2.—Reduce the fracture. To do this satisfactorily it may be necessaryto pass a strong suture transversely through the tendo patellae as a tractor. * For a full discussion of the accident and its treatment see Gaudier and Bouret, Rev. deChir., Sept., 1905. FRACTURE HEEL 933 The suture may be eventually used as a means of fixation by passing it througha hole bored in the tibia. Step 3.—Unite the fractured tubercle to the tibia by means of periostealsutures or of bone pegs, nails, or a wire suture (Fig. 1124). If the knee-jointis open, close it with sutures. Step 4.—Close the external wound without drainage. Dress. Treat likefractured Fig. 1123.—Fracture of tibial tubercle. V. Fractures of the external malleolus often lead to impairment of movementof the ankle-joint. This is due to the fact that the fracture opens the joint andthe subsequent callus formation leads to a chronic inflammation of the (Lancet, Feb. 7, 1914) reports three cases in which he removedthe detached malleolus and obtained a quick convalescence and perfectfunction in each. The support which the malleolus normally gives theankle-joint is restored by a thick fibrous mass of tissue. This measure
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