FRAG T IT R E S 
or 
THE PATELLA, 
TREATED BY A SING, 
WITH CASES. 
PAUL F. EVE, JA.D. 
iNasfjxrilie, Qlenn.: 
UNIVERSITY MEDICAL PRESS—W. H. F. LIGON, PRINTER. 
1867. FRACTURES OF THE PATELLA, 
TREATED BY A RING, WITH CASES. 
Another benefaction has been given to humanity by the Pro- 
fession, in the treatment of a very difficult, though fortunately 
not very frequent, accident. The name of Dr. W. A. Gibson of 
St. Louis, U. S., will hereafter ever be honorably associated with 
the management of a fractured Patella ; for by the suggestion of 
a ring, he has not only simplified, but we think, probably per- 
fected, a method for treating these cases, whether the bony solu- 
tion be transverse, oblique, longitudinal, stellate, or by commi- 
nution. A moment’s reflection will convince medical men that 
of all means proposed to retain the fragments of a fractured pa- 
tella in contact, and thus promote bony union, instead of the 
ligamentous one usually obtained in practice, the ring must have 
great and decided advantage, and is so simple in application, that 
the thought almost involuntarily arises, Why was it not suggested 
sooner ? And this is the more surprising v/hen we consider the 
many various methods employed to keep the fractured parts in 
contact. The two plates of metal shaped like a horse-shoe, to 
fix and bring together the fragments, invented by the late Mr. 
Lonsdale : the plates with two sharp hooks, of M. Malgaigne, 
recently deceased ; and the practice of Mr. J. Wood, of King’s 
College Hospital, London, consisting of strappings encircling the 
upper and lower margins of the broken bones, and then crossing 
each other at the sides of the point to be fastened to hooks at- 
tached to a wide splint in the popliteal region : would all seem 
suggestive of the value of a ring under these circumstances. 4 
lii the future treatment of fractures of the bone under con 
sideration, a revolution may be predicted, and the prognosis, 
change, in the result, from ligamentous to bony union. For as 
Mr. Carsten Holthousc says, in “Holmes’ Surgery,” the great 
rareness of bony union in transverse fractures of the patella is 
owing simply to the difficulty of keeping the fragments in suffi- 
ciently close apposition ; when this is accomplished, bony union 
occurs as in other fractures. 
The idea so long entertained in treating fractures of the patella 
by position, so as to relax the quadriceps fernoris muscle, we see 
hy the October No., 1866, of the London Medical Times and 
Gazette, is now being abandoned, and Mr. Paget, at St. Bar- 
tholomew's Hospital, has been treating his cases for the past 
three years in the horizontal position. When, too, we reflect 
that only one (the rectus fernoris) of these four muscles arises 
from the pelvis, while the others, the crureus and the two vasti, 
have their attachments to the shaft of the femur itself, we must 
be convinced how little position can effect in these cases. The 
fact is that after a day or two, the muscles relax spontaneously 
and the easiest and most unrestrained position of the limb has 
been found not only the most agreeable to the patient, but as 
good in its results. 
We now give the case furnishing the occasion for introducing 
the ring in the treatment of fractured patella, followed by the 
two in which it has been employed in this city. Dr. Gibson 
published this in the September No. of the St Louis Medical 
and Surgical Journal. The patient, Mr. Janies Ferree, aged 35 
years, had been the victim of rheumatism, and having so far 
recovered that he could use crutches, in attempting to get into a 
buggy, felt a sudden shock, as if some one had Kit him with a 
stone on the knee, and could scarcely be convinced that the frac- 
ture was caused by muscular contraction. 
“ The patella of the left knee was fractured transversely 
through its middle, the fragments separating about one inch. I 
did not admire any of the modes of treatment for the fracture 
which I had ever seen recommended or used, and while hesitating 
as to wliat plan I would adopt, it occurred to me that a ring 
would answer the purpose, i therefore took a measurement of 5 
the sound patella, and had a ling made of iron (allowing for 
padding), which I padded well wadding, cut in strips 
and wrapped around the ring, over which I applied a bandage 
To each side of the ring I sewed strips of bandage. I then 
placed a well-padded splint twenty-four inches long to the pos- 
terior aspect of the leg and thigh, which I secured by a few turns 
of bandage at the lower and upper, ends, the bandage being loose 
so as not to interfere with the circulation. I next brought the 
two fragments of hone into apposition, and placed the ring 
around the patella, and tied the strips of bandage over the splint, 
thus securely holding the ring in its place, and keeping the 
broken hone always in complete apposition, thereby giving the 
greatest possible chance for a bony union. At the expiration of 
thirty days, I removed the ring, and commenced passive motion 
of the limb, and to-day (June 15th) he has very good use of the 
limb. During the time this case was under treatment, I invited 
Drs. E. IT. Gregory, J. J. McDowell, E. A. Clark, E. S. Frazier, 
and other physicians, to examine the appliance, and they all ex- 
pressed the opinion that it was just the thing for a fractured 
patella. The advantages of the ring in the treatment of this 
troublesome fracture arc so apparent, that it seems to me hardly 
necessary to point them out. The appliance did not give the 
patient the least pain, and there was no interruption of the cir- 
culation by the bandages. It was impossible in this case tor the 
patella to escape from the ring, but possibly Im-some cases, as of 
women, when there is a good deal of adipose tissue, and but 
little prominence of the patella, it may not be so easy to apply 
the ring ; but I am persuaded that it will give entire satisfaction 
in all cases. I claim by the application of the ring to have re- 
duced one of the ugliest fractures of the human frame to one of 
the simplest for treatment. 
“ I report this case for the information of the profession, feel- 
ing confident from the perfect success of this case that the ring 
has never been used before, or we certainly would have been fa- 
miliar with its use.” 
Case: 2d.—On Sunday, the 28tli day of last October, I. was 
called to Lawson MarsliaJl, a colored youny; man, who by a fall G 
on a rock, in a state of inebriation, had fractured the left patella, 
directly transverse, in about the middle of the bone. There 
existed a separation of some two or more inches between the 
fragments. He had apparently a good constitution, and was in 
excellent health. 
The usual carved and straight splint was applied to the pos- 
terior surface of the limb after reduction of the fracture, as re- 
commended by Sir Astley Cooper, viz., by a broad belt around 
the lower part of the thigh, just above the upper fragment, then 
by a long bandage passing down from it at right angles on one 
side, under the sole of the foot, from which extension was made 
by ascending the other side parallel to the leg, and securing it to 
the same circular belt. 
Within two weeks after this, the September No. of the St. 
Louis Journal was received, the case of Hr. Gibson noticed, and 
his practice at once adopted. The ring was worn five weeks, the 
latter three without the posterior splint. At first it was padded, 
then applied directly to the surface. It is made of brass, softer 
than iron. It has answered every purpose in the treatment, and 
numerous witnesses, besides our class, saw this case, and all bear 
testimony to the great value of this method. I consider it the 
perfection (humanly speaking) in the treatment of fractures of 
this bone. One suggestion, however, is added, that the ring 
should be worn for three or four months, the patient being per- 
mitted to go about—mine refused to wear it longer than five 
weeks, making the whole treatment about seven weeks. The 
ring too might be slightly curved at the sides towhich are secured 
the strips or bandlets to fasten it under the knee. 
Case 3d.—By a railway accident, during the night of the 18th 
of December, Mr. G., aged 29 years, and of fair constitution, 
received an extensive contusion over the right lower extremity, 
falling as he thinks, with his knee against the stove of the car, 
which caused a transverse fracture of the patella. Such was 
the injury to the soft part that twelve days were required of ac- 
tive treatment to subdue the resulting inflammation, and more 
than thirty, after it, the discoloration in the integument of the 
limb is quite apparent. In the mean time, the family physi- 7 
sician, Dr. Thomas Menees, the President of the Is ashville Medi- 
cal Society, had consulted me in regard to the best management 
of the case, and when the ring, as advised by Dr. Gibson, was 
proposed, he at once approved of it, had one made and applied. 
If has now been worn uninterruptedly three weeks, keeping 
fragments in close apposition, and there exists every prospect of 
a bony union. 
The patient was up to-day, the 21st of January, in his chair. 
With nbthing but the ring on, he stood upright, of course not 
on the injured limb, and commenced passive motions in the knee- 
joint. For security he still wears a splint of binders’ beard 
when out of bed. 
Dr. Menees is fully satisfied that this simple treatment fulfills 
every indication, and is the best yet devised for a broken patella. 
Feb’y Ist—This patient is out on the street, with a cane, 
ready to resume business. With the ring he not only walks well, 
but can flex the leg nearly at right angle without inconvenience.