SECT. CIII.—ON THE PATELLA.
The patella is a porous bone kept firmly in its place by the parts above and below, and is often crushed but seldom fractured. It undergoes fracture also through its thickness, and is broken into small pieces, with or without a wound. The symptoms are obvious,—a solution of continuity, a hollow, and crepitation. The fracture is put in order by extending the leg, for thus the divided portions may be brought together with the fingers, until the lips of the fracture mutually touch, and are united to one another, and fractured pieces, when separated, are thus arranged together. For even if callus does not take place, owing to the parts being drawn in different directions by the muscles and tendons from the thigh and leg, which are inserted into it, yet the separation is much diminished. But it occasions much lameness to the patients; for, when they attempt to labour, the knee cannot sustain them long, and in walking their ascent upwards is impeded; but in moving along a plain their lameness is not perceptible. In ascending, however, as the knee cannot bend in raising and setting down the leg, the lameness becomes apparent. And in this case any bone that irritates is to be taken out where it protrudes, and proper treatment applied.
Commentary. None of the ancient authorities have given so full an account of this accident as our author. Hippocrates and Celsus have omitted it altogether. Soranus merely gives the symptoms, namely, a hollowness in the part and crepitus.
Albucasis recommends us, after arranging the broken pieces of bone, to apply a round splint over it if necessary. Rhases likewise speaks of applying a well-stuffed splint. Haly’s account is distinct but similar to our author’s, from which it is abridged. Neither he nor Avicenna makes any mention of a splint.