The question of operative interference in recent, simple fractures of the patella / by Charles A. Powers.

  • Powers, Charles A.
Date:
1898
Catalogue details

Licence: Public Domain Mark

Credit: The question of operative interference in recent, simple fractures of the patella / by Charles A. Powers. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    place to call attention to but three or four of these. First and best known, the general plan of making the closest possible approximation of the fragments, after subsidence of the joint swelling, by properly applied bandages or strips of sticking- plaster, and then confining the limb on a splint or in a plaster- of-Paris dressing. Of the various posterior splints Agnew’s is perhaps as suitable as any. In approximating the frag- ments care is taken to see that they tilt as little as possible. Millar, of Edinburgh, thought that the interposed apo- neurotic tissues could be removed by friction, but this is im- probable. Bony crepitus may indicate c^tact at one point only. Early aspiration of the joint effusion may succeed if done before the blood clots, but this clotting takes place early, and after it occurs the joint can only be emptied by a broad trocar and canula. This, with or without irrigation, may well be thought almost as serious a procedure as open operation. The use of Malgaigne’s hooks, or of the modifications by Levis or Otis or Duplay, as an aid to coaptation seems to have declined. Treves speaks well of them, and they are still used to a moderate extent in France. I have seen but little of the method, but do not judge that they give results superior to simple dressings. The most valuable of the non-operative forms of man- agement I take to be that of massage, the so-called “ Dutch” method. Introduced by Tilanus, of Amsterdam, in 1885, this measure has had extensive trial, and all who have em- ployed it speak well of it, A brief description is as follows: During the first twenty-four or forty-eight hours the limb is elevated and the joint compressed by an elastic bandage. On the second or third day the massage is commenced, and should be carried out by the medical attendant himself. The upper fragment is fixed by the fingers of one hand, while with the other gentle massage is made from the knee along the thigh muscles. If an assistant steadies the fragments both of the surgeon’s hands can be used in this. Effleurage or strok- ing of the knee is made: the muscles are to be kneaded. The
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