The operative treatment of the patellar fracture by a sound technique - abstract

For many many years the operation for patellar-fracture has been a matter of discussion - perhaps because of the fact that the surgeons tried to repair the fracture instead of repairing the extensor-function. It seems to be scarcely possible to treat this fracture and reach consolidation in a satisfactory way and surgeons have tried to use all kind of material for fixation of the fragments without success. The treatment of this problem should not be directed towards the healing of the fracture, but should be towards the elimination of the fracture by excision of the smallest part, and in case of communitative fractures the subperiostal excision of all fragments but one. It is about 1936 that Dr. Hustinx proposed this way of treatment. We have treated 25 cases of patellar-fractures from 1959 till now, following a special technique to reconstruct the extensor-apparatus, and using a frontal perforation of the remaining patellar-fragment. After suturing with interrupted catgut chromium, security is ensured by passing twice a tobacco-bag strong chromium catgut around the whole interruption in the extensor apparatus and through the hole perforated in the remaining fragment of the patella. If this is completed it is possible to mobilize the patient with plaster (pipe) after 24 hours. In this way there will be no obvious wasting of the musculature and if the plaster is removed in 3 or 4 weeks restoration of function of the knee, can be easily achieved in 3 or 4 weeks. It is only exceptional that it takes a long time to reach a 90 degree flexion of the knee. We feel that because of the good results we have obtained in the past ten years, we should recommend this technique as a routine way for treatment of this affection (AU)

Four unusual osteolytic lesions

A brief account is given of four osteolytic lesions seen within the past year at U.H.W.I. The symptoms and clinical findings are described. The radiographic, macroscopic and microscopic appearances are noted and illustrated in each case (AU)