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A closed method of reduction of fracture of the patella
A CLOSED METHOD
OF REDUCTION
OF
FRACTURE OF THE PATELLA GATEWOOD, CHICAGO,
T
FIG.
HERE is no fracture which Iends itseIf to open reduction more uniformIy than compIete fracture of the
I. Comminuted fracture of right separation of fragments.
pateHa.
M.D.
ILL.
spIint applied to the Ieg and the patient transported to the Presbyterian Hospital. On examination,
Note
there
were no noteworthy
physica
FIG. 2. Fragments of pateIIa approximated by use of rubber bands attached to hooks fastened in moIeskin adhesive. A, shadow cast by cardboard incorporated in adhesive.
pateIIa. Most recent texts scarceIy mention cIosed methods of treatment. FrequentIy, however, either the genera1 condition of the patient or some IocaI compIication makes operative reduction inadvisabIe or undesirabIe. In such a case, I have devised a method which I have not seen reported eIsewhere, aIthough the principIes invoIved are we11 estabIished. Dr. W. R. C., a heavy-set man of fifty-five, was thrown from his automobiIe near HockerviIIe, OkIahoma. He received a fracture-disIocation of his Ieft humerus and a transverse comminuted fracture of his right pateIIa. The disIocation was reduced by a IocaI physician, a 28
defects other than the foIIowing: The region of the Ieft shouIder was swoIIen and discolored. Roentgenograms showed a chip off the margin of the gIenoid, but compIete reduction of the shouIder. The right knee was greatIy swoIIen and discorored. A large infected abrasion covered the prepateIIar region. The patient couId not extend the Ieg, but couId fIex it to a right angIe. The x-ray fiIms (Fig. I) reveaIed a fracture of the pateIIa with considerabIe separation of the fragments. On account of the infection, it was necessary to resort to some cIosed method of treatment
New
Srnrre.s
VOL.
XSI,
No.
which would permit
I
Gatewood-Fracture of frequent
change of
dressings
to the prepateIIar region. This was accompIished in the following manner: A
FIG. 3. Method
of Patelln
29
tape-splint, method, originally described by Agnew,’ was used with good results in the case of King Edward VII of England
of dressing infected prepatellar region and maintaining pateIIa at same time.
rectanguIar piece of moleskin adhesive, measuring about 6 by 8 inches, was prepared by fastening a one-inch strip of heavy cardboard ta one of the Ionger margins and setting into it with a shoemaker’s eyelet-set several shoehooks, about $6 inch apart. The adhesive was appIied over the lower part of the thigh just above the infected area as shown in Figure 2. The Ieg, fuIIy extended, was encased in a cast. A Iarge rectanguIar window was then made in the patellar region. Similar hooks were attached to two other pieces of adhesive which were incorporated in the cast just below the knee. FinaIIy strong rubber bands were strung between the upper and iower hooks. These served the doubIe purpose of keeping the dressing in place and of maintaining suficient tension to overcome contraction of the quadriceps extensor. They were tightened as often as necessary to keep up the tension. Although the method was primarily pIanned to prevent separation of the fragments unti1 the infection had subsided, the resuIt was so satisfactory (Fig. 3) that the method was continued for six weeks after which active and passive movements were instituted.
Amcric:~n Jrmrnal <,I Surwr-v
apposition
of separated
fragments
of
who sIipped, whiIe descending a spiral staircase at Baron RothschiId’s Manor and fractured his left pateIIa. Sir William MacCormac,2 after consultation with Lord Lister and others, apptied a fenestrated cast and overIapped strips of adhesive carrying them obIiqueIy from the suprapateIIar region to the cast. While the open method of reduction permits of accurate approximation and usuaIIy gives esceIIent resuIts, infection almost invariably produces ankvlosis and sometimes great disability. In spite of the fact that union by the closed method is probabIy always fibrous and in powerful individuals considerabre separation of the fragments may occur, the functional result in this case has been so good that 1 believe its use is justified in selected cases. SUMMARY
The principIe of Buck’s extension was used many years ago in the treatment of fracture of the pate& A rope or cord was
A modified traction cIosed method for the treatment of seIected cases of fractured patella is described, It is a method which permits the patient to be partially ambuIatory. It has given an exceIIent result in the case in which it was empIoyed.
attached to a block which in turn was fastened to the thigh with adhesive, traction being maintained by carrying the cord over a puIIey at the foot of the bed and attaching a weight to it. The adhesive
I. American Text Book of Surgery. Ed. 3, Phila., Saunders, 1899, p. 327. 2. The accident to the Prince of Wales. Lancet, 2: 22 I, 1898.
REFERENCES
OF REDUCTION
OF
FRACTURE OF THE PATELLA GATEWOOD, CHICAGO,
T
FIG.
HERE is no fracture which Iends itseIf to open reduction more uniformIy than compIete fracture of the
I. Comminuted fracture of right separation of fragments.
pateHa.
M.D.
ILL.
spIint applied to the Ieg and the patient transported to the Presbyterian Hospital. On examination,
Note
there
were no noteworthy
physica
FIG. 2. Fragments of pateIIa approximated by use of rubber bands attached to hooks fastened in moIeskin adhesive. A, shadow cast by cardboard incorporated in adhesive.
pateIIa. Most recent texts scarceIy mention cIosed methods of treatment. FrequentIy, however, either the genera1 condition of the patient or some IocaI compIication makes operative reduction inadvisabIe or undesirabIe. In such a case, I have devised a method which I have not seen reported eIsewhere, aIthough the principIes invoIved are we11 estabIished. Dr. W. R. C., a heavy-set man of fifty-five, was thrown from his automobiIe near HockerviIIe, OkIahoma. He received a fracture-disIocation of his Ieft humerus and a transverse comminuted fracture of his right pateIIa. The disIocation was reduced by a IocaI physician, a 28
defects other than the foIIowing: The region of the Ieft shouIder was swoIIen and discolored. Roentgenograms showed a chip off the margin of the gIenoid, but compIete reduction of the shouIder. The right knee was greatIy swoIIen and discorored. A large infected abrasion covered the prepateIIar region. The patient couId not extend the Ieg, but couId fIex it to a right angIe. The x-ray fiIms (Fig. I) reveaIed a fracture of the pateIIa with considerabIe separation of the fragments. On account of the infection, it was necessary to resort to some cIosed method of treatment
New
Srnrre.s
VOL.
XSI,
No.
which would permit
I
Gatewood-Fracture of frequent
change of
dressings
to the prepateIIar region. This was accompIished in the following manner: A
FIG. 3. Method
of Patelln
29
tape-splint, method, originally described by Agnew,’ was used with good results in the case of King Edward VII of England
of dressing infected prepatellar region and maintaining pateIIa at same time.
rectanguIar piece of moleskin adhesive, measuring about 6 by 8 inches, was prepared by fastening a one-inch strip of heavy cardboard ta one of the Ionger margins and setting into it with a shoemaker’s eyelet-set several shoehooks, about $6 inch apart. The adhesive was appIied over the lower part of the thigh just above the infected area as shown in Figure 2. The Ieg, fuIIy extended, was encased in a cast. A Iarge rectanguIar window was then made in the patellar region. Similar hooks were attached to two other pieces of adhesive which were incorporated in the cast just below the knee. FinaIIy strong rubber bands were strung between the upper and iower hooks. These served the doubIe purpose of keeping the dressing in place and of maintaining suficient tension to overcome contraction of the quadriceps extensor. They were tightened as often as necessary to keep up the tension. Although the method was primarily pIanned to prevent separation of the fragments unti1 the infection had subsided, the resuIt was so satisfactory (Fig. 3) that the method was continued for six weeks after which active and passive movements were instituted.
Amcric:~n Jrmrnal <,I Surwr-v
apposition
of separated
fragments
of
who sIipped, whiIe descending a spiral staircase at Baron RothschiId’s Manor and fractured his left pateIIa. Sir William MacCormac,2 after consultation with Lord Lister and others, apptied a fenestrated cast and overIapped strips of adhesive carrying them obIiqueIy from the suprapateIIar region to the cast. While the open method of reduction permits of accurate approximation and usuaIIy gives esceIIent resuIts, infection almost invariably produces ankvlosis and sometimes great disability. In spite of the fact that union by the closed method is probabIy always fibrous and in powerful individuals considerabre separation of the fragments may occur, the functional result in this case has been so good that 1 believe its use is justified in selected cases. SUMMARY
The principIe of Buck’s extension was used many years ago in the treatment of fracture of the pate& A rope or cord was
A modified traction cIosed method for the treatment of seIected cases of fractured patella is described, It is a method which permits the patient to be partially ambuIatory. It has given an exceIIent result in the case in which it was empIoyed.
attached to a block which in turn was fastened to the thigh with adhesive, traction being maintained by carrying the cord over a puIIey at the foot of the bed and attaching a weight to it. The adhesive
I. American Text Book of Surgery. Ed. 3, Phila., Saunders, 1899, p. 327. 2. The accident to the Prince of Wales. Lancet, 2: 22 I, 1898.
REFERENCES