This is best treated by pegging the tuberosity in position, and fixing the extended limb on an inclined plane to relax the quadriceps muscle.
In young, athletic subjects, the tongue-like process of the epiphysis ([Fig. 85]), into which the ligamentum patellæ is inserted, may be partly or completely torn away, giving rise to localised swelling, and pain which is aggravated by any muscular effort—Schlatter's disease or “rugby knee.” It has been frequently observed in cadets as a result of kneeling at drill. The treatment consists in rest and massage, but the symptoms are slow to disappear.
The condition is liable to be mistaken for some chronic inflammatory condition of the bone, such as tubercle, unless an X-ray examination is made.
The upper end of the fibula is seldom broken alone. The chief clinical interest of this fracture lies in the fact that it may implicate the common peroneal nerve, and cause drop-foot.
Dislocations of the Knee
Dislocation of the knee is a rare injury, and occurs as a result of extreme degrees of violence, especially of a wrenching or twisting character.
Rupture of the popliteal vessels, or pressure exerted on them by the displaced bones, may lead to gangrene of the limb, and necessitate amputation. The common peroneal nerve is frequently damaged. When the lesion is compound, also, amputation may become necessary on account of infective complications.
The varieties of dislocation are named in terms of the direction in which the tibia passes: forward, backward, medial, and lateral.
Dislocation forward is the most common variety, and results from sudden hyper-extension of the knee, tearing the collateral and cruciate ligaments. The leg remains fully extended, and lies on a plane anterior to that of the thigh. The condyles of the femur are palpable posteriorly, and the skin is tightly stretched over them, or may even be torn, rendering the dislocation compound. The patella is projected forward, the quadriceps tendon is lax, and the skin over it is thrown into transverse folds. The limb is shortened by two or three inches.
Dislocation backward is usually due to a direct blow driving one of the bones past the other. The leg remains hyper-extended, the head of the tibia occupies the popliteal space, while the lower end of the femur projects forward with the patella either in front or to one side of it.