Fracture of the patella is generally caus ed by violent exertion of the muscles, whose tendons are inserted into this bone, and not by direct violence. The upper end of the bone is drawn upwards by the muscles, and a total inability to extend the leg is generally observed. The mus cles should be relaxed, by extending the knee, and bending the thigh on the pel vis : they may also be surrounded with a roller, a compress being placed just a bove the upper portion of the broken bone. The newly-formed substance which unites the broken ends is of a liga mentous or cartilaginous nature, and not bony.
Fractures of the leg. If they affect both bones, there can be no doubt of the na ture of the case ; but the symptoms are more uncertain, when the fibula alone is broken. The limb should be laid on its outside, with the knee moderately bent. Japanned iron, or wooden splints shaped to the part, and covered with soft pads, are employed. The leg having been placed in the above mentioned position, extension is made, if necessary ; and the under splint, covered with its pad, and having an eighteen-tailed bandage laid on it, is passed under the limb. Having ob served that the ends of the bones are in exact contact, the surgeon places his soap plaster over the fractured portion, and lays down the bandage. Another soft pad
is then put over the upper surface of the leg, and the other splint applied. The leather straps attached to the splints are fastened with sufficient tightness, to pre vent any motion of the fractured part. When the pressure of the splints is pain ful, soft pads are necessary.
Ruptured tendo Achillis. The large ten don of the muscles of the calf of the leg is sometimes torn asunder by the violent exertion of those muscles. An inability to extend the ankle, and a consequent im paired power of progression, follows. The ends of the tendon may be approxi mated by straightening the ankle and bending the knee. The foot may be kept in this position by the assistance of bandages. The case requires about the same degree of confinement as a fracture. Some persons have not kept their bed for this accident, but have walked about with a high-heeled shoe. The tendon of the plantaris muscle is sometimes rup tured, and the accident is attended with the symptoms as if the tendo Achillis were torn.