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.
SECT. CIV.—ON THE LEG.
The treatment of fractures of the leg corresponds with that of the fore-arm, for it consists of two bones, the thicker of which bears the same name (tibia), and the small one, from its resemblance, has been called fibula. Its fractures also admit the same varieties, being deranged on all sides when both the bones are broken together, and to three when only one, namely, within, without, and the tibia backwards and the fibula forwards. Wherefore it is to be set in the same manner by the hands, or ligatures, sometimes applied to the leg itself, and sometimes to the thigh, (for the knee being a strong joint can bear the extension uninjured,) and ligatures are to be applied likewise below the fracture, as we mentioned under the head of the fore-arm. The case is to be managed otherwise, as described by us in the section on the arm.
Commentary. Hippocrates has treated of this case at considerable length. The bandages are to be applied as formerly described, and the leg laid on a level board with a soft cushion under it. It is clear that he did not approve of the bent position of the limb. The splints are to be applied on the seventh or eleventh day. Of the fractures of a single bone, that of the tibia, he remarks, is the worse, a fractured fibula being easily managed. He gives particular directions to attend to the state of the heel.
Celsus treats of these fractures in general terms, like those of the fore-arm. Albucasis directs us to apply two splints made of the wood of pines or palms, of moderate thickness, and of such length as to extend from the knee to the feet. One of these is to be placed below the leg and the other above; and they are to be tied in three places, namely, at the extremities and in the middle.
The other Arabians treat of these fractures in more general terms.