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The inflammation was but little influenced by this or any other treatment. The knee continued to slowly and surely enlarge. And this extended upward without first producing any great distention of the synovial sack under the patella. There seemed to be simply enlargement of all the tissues of the lower part of the thigh.
In many places, even at the distance of three and four miles from the coast, I found on the gravel-capped surface of the 245-255 feet, and of the 330 feet plain, shells of Mytilus Magellanicus, M. edulis, Patella deaurita, and another Patella, too much worn to be identified, but apparently similar to one found abundantly adhering to the leaves of the kelp.
Here are several species of the genera Murex, Fusus, Buccinum, Mitra, Trochus, and Turbo. Further, there are found here a large Fissurella, and six species of a genus which, from its simple, unwound shell, would be immediately taken for a Patella; the creature, however, closely resembles the Fissurella, with the difference that only one gill is visible in the fissure over the neck.
Steward, take off my coat so; my neckerchief now; I must be perfectly unencumbered, Surgeon Patella, or I can do nothing whatever."
There are, further, the suture wires in the knee-caps; Sir Morgan Bennett, having looked up the notes of the operation, informs me that he introduced three suture wires into the left patella and two into the right; which is what the skiagraph shows. Lastly, the deceased had an old Pott's fracture on the left side.
This rotation is seen while the arm is being raised from the horizontal to the vertical position, and is effected by the cooperation of the trapezius with the serratus magnus muscles. The patella, or knee-pan, the two condyles of the tibia, the tubercle on the tibia for the attachment of the ligament of the patella, and the head of the fibula are the chief bony landmarks of the knee.
These facts furnish us with indications as to the seat and method of amputation. Experience has proved that in senile gangrene of the lower extremity the most reliable and satisfactory results are obtained by amputating in the region of the knee, care being taken to perform the operation so as to leave the prepatellar anastomosis intact by retaining the patella in the anterior flap.
The internal trochanter was also fractured in four small pieces. In this case it is fair to suppose that the mule in trying to regain footing on a slippery floor violently abducted the legs and fracture resulted. It is possible also that a temporary luxation of the patella took place first and caused the animal to struggle in such manner that fracture followed.
Pebbles and Patella alike are half-covered with Confervae, and from the top of the latter, fronds of Ulva are often found floating like flags. I have one with a clump of Corallina rising from its apex, like a coppice on the summit of a hill.
No difficulty is encountered in recognizing the fracture of the patella because of the exposed position of the bone. Crepitation, and in some cases fissures, may be easily detected. Treatment. In simple fracture, when treatment is thought advisable, the subject is put in a sling and kept as nearly comfortable as possible.
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