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Image from page 470 of “A practical treatise on fractures and dislocations” (1912)
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Identifier: practicalt00stim
Title: A practical treatise on fractures and dislocations
Year: 1912 (1910s)
Authors: Stimson, Lewis Atterbury, 1844-1917
Subjects: Fractures Dislocations
Publisher: New York, Philadelphia, Lea & Febiger
Contributing Library: The Library of Congress
Digitizing Sponsor: The Library of Congress
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Text Appearing Before Image:
le, or inability to make complete active extension, thelimb remaining slightly flexed. These disabilities coincide with and presumably depend upon thevarying conditions of the fragments and uniting bond which have beendescribed. Inability to flex appears to be largely due to retraction of the portionof the capsule attached to the upper fragment and of the fascia lata onthe outer side, especially of the upper side of the rent in the lateralexpansion, and sometimes to enlargement of the patella, itself theresult of hypertrophy of the fragments or of a short stiff bond betweenthem which makes the bone too long to turn over the curve of thecondyles. Retraction of the quadriceps seems not to be an importantfactor in this disability. (See also the section on Disability AfterFracture.) Loss of active extension, when marked and when combined withfree flexion, is due to insufficient union between the fragments and theabsence of complementary fascial connections between the quadriceps Fig. 290.
Text Appearing After Image:
Extreme separation of the fragments after fracture of the patella. and the leg, such as are found in some cases. It is most marked whenthe fracture is in tlie lower half of the bone, because of the loss of thelower fibres of tlie vasti. It is remarkable that this loss interferes soslightly with ordinary use of the limb in most cases ; the patients oftenwalk easily and securely, althougli they are exposed to fall whenevtTtheir weight rests only on the partly flexed limb. Tliey seem instino- 414 FRACTURES. lively to depend upon the sound limb whenever the use of the damagedone would be unsafe. There is difficulty in going up and down stairsand in rising from a seat. In the case represented in Fig, 230 thepatient claimed not to be aware of any noteworthy defect in the limbalthough active extension, was almost entirely absent. The common defect is slight limitation of active extension, thepatient being unable to raise the heel from the bed without firstslightly flexing the knee. Degenerat
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