Ars chirurgica a compendium of the theory and practice of chirurgery in seven books ... shewing the names, causes, signs, differences, prognosticks, and various intentions of curing all kinds of chirurgick diseases ... : to which is added Pharmacopoeia chirurgica, or, The medical store, Latin and English ... / by William Salmon ...

CHAP. XXXII. Of a FRACTƲRE of the KNEE-PAN.

I. IT is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, i.e. Pelvis, vel Patine parvae; in Latin, Fracture Fatellae; and in English, A Fracture of the Knee-pan.

II. This Bone is sometimes bro∣ken lengthways in respect to the Thigh, sometimes transverse, and sometimes obliquety: sometimes it is broken into two parts, sometimes, all manner of ways; and sometimes it is with a Wound, and sometimes with∣out.

III. The Signs. It is easily known

by feeling; there is a distance be∣tween the broken Bones, and the Patient has a weakness and dis∣ability in going: it is also known by the cavity, which is in the place where the Fracture is; by its motion; and by the crashing sound, in the handling the roof.

IV. Prognosticks, If tis rightly set, and so preserved, it easily grows to∣gether again; especially if the Fra∣cture was made in the length thereof.

V. If the Fracture is made transverse or crossways, the Patient proves lame, and for the most part halts all his Life after.

VI. So also if it is broken ob∣liquely; because in both these ways, the concretion of the Callus being produced, the con∣solidation does hinder the free motion of the Knee.

VII. If it is broken longways, it is easily reduced, and consolida∣ted, without any fear of a Callus bunching forth, or a Lameness fol∣lowing thereupon: because the extremities of the seventh, eighth, and ninth Muscles, which move the Ancle and Leg, end in that most strong Ten∣don which is implanted in the Patella; and that the Muscles are wont of their own accord to be moved, and to draw towards the place of their original.

VIII. But Par•…•…us, lib. 14. cap. 22. says, he never saw any one who had this Bone broken, that was not same, and halted all their Lives after: for that the concretion of the Callus being produced, the consolidation does hinder the free bending of the Knee.

IX. This indeed, as to the Trans∣verse Fracture, may be granted; yet, says Fabricius Hildanus Cent. 5. Obs. 88. this is not always necessary in the Fracture made longways; because such a Callus so sticking forth, is not of ne∣cessity to be bred: and we may see in the coalition of other Bones, that Nature many times breeds a Callus with that near∣ness, that there scarcely remains the least sign of any Fracture upon the Part.

X. And this more especially happens when the Periosteum is whole, or unbroken; for then it keeps in the matter of the Cal∣lus, that it cannot grow out overmuch, or bunch, cut too far.

XI. Again, being broken trans∣versly or obliquely, tho' all the industry is used that can be, it is not to be cured without Lameness or Halting ever after; because the seventh, eighth, and ninth Mu∣scles, moving the Ancle, draw the one part of the Bone up to∣wards the Hip: but the Tendon that under the Knee is inserted into the Shin-Bone, draws the other part of the Bone down∣wards; so that they can hardly by any Art be conglutinated again: whereupon a Callus bunches forth; which hurting the Muscles moving the Leg and Ancle, causes Lameness.

XII. The Cure. If the Knee-Pan is broken lengthways, no ex∣tension is to be made; because the pieces of the Bones remain those ways in their places.

XIII. If it is broken transversly or obliquely, as the two pieces fly one from another, so here an exten∣sion is to be made; and the Artist is at the same time to thrust

back the upper part of the Ratella into its true place; and in this posture it is to be kept, during the time of the Cure.

XIV. Then a Cataplasm or Em∣plaster proper to the Fracture is to be laid on; and the hollowness of the Ham is to be filled up with a Bolster, lest the Knee should bend unawares, whereby the fragments of the Patella would fly asunder.

XV. After which, the Part is to be bound up with a fitting Liga∣ture, if it is broken crosswise, &c. the Swath ought to be four Yards long, and two Inches broad, which may be rowled up, with one or two Heads: it is to be applied above the Knee-pan, making a circumvolution, and crossing un∣der the Knee; then the Swath is to be constantly carried up and down, 'till the Patella is wholly covered.

XVI. If the Fracture is long∣ways, a Swath like to the former must be used, which must be divi∣ded, or cut thro' in the middle: and is first to be applied under the Knee; and one of the Heads of the Swath is to be passed thro' the Cut, by which the Bones are to be well closed, with several circumvolutions made upon the Patelia, 'till it is all covered.

XVII. Aegineta, de Re Me∣dica, lib. 6. cap. 103. will have the Leg extended, and the Patella joined with the Fingers, and so kept, 'till the edges of the broken Bone touch one another, and are grown together: this may indeed be advised; but I am afraid, that it is a very hard thing to be performed.

XVIII. Then with a Junck of Straw, or made of some other fit substance, (as in a Fracture of the Thigh or Leg) the Member is to be kept fixt and immoveable, taking care that the Knee is not bended in the least measure.

XIX. If sharp fragments of Bones are separated from the rest of the Bone, and prick the Skin; some there are, who advise to make incision, to take them out; but this, if done, ought to be performed with great care and caution; and if any vehement Symptom should succeed, you are timely to oppose it with proper Remedies.