131. As soon as the consolidation is complete, the motions of the
limb must commence. These, at first gentle and confined, must be
afterwards, increased in extent, and more frequently repeated, till, at
length, the limb should be exercised every day for two or three hours
without intermission. The position and direction of the leg ought to
be constantly changed. One while, the thigh should be elevated by a
bolster, so as to flex the leg; at another time, the bolster should
be fixed under the leg to keep it extended. The rotula must be moved
in every direction, and, as soon as the patient can leave his bed, he
should take exercise himself. These precautions are more necessary here
than in any other fracture, because a stiffness of the parts adjacent
to the joint, is always the inevitable consequence of a long state of
rest. Certainly writers would not have considered anchylosis as the
most favourable termination of such fractures, had they been acquainted
with the effect of exercise and rest in that now under consideration.
132. Provided the mode of treatment here laid down be faithfully
pursued, the affection is seldom accompanied by those numerous
accidents, of which so much has been said. The callus is formed in the
usual manner: and, on some occasions, where the patients have died at
the Hotel-Dieu, in consequence of some affection not connected with the
fracture, the two condyls have been found perfectly united together
and to the body of the bone. An instance of this kind is recorded in
the Journal of Surgery.
133. Let us, in the mean time, not speak too favourably of that,
respecting which the ancients were accustomed to speak too
unfavourably. Even the practice of Desault would expose our error.
Sometimes the most assiduous attention, and the most careful
application of the apparatus, have not been sufficient to prevent
abscesses around the knee, and an anchylosis of the joint. Desault
related a case where even a caries of the articulating surfaces
occurred. But some extraneous circumstances appeared to have an
influence in these instances: and it may be laid down as a general
rule, that fractures of the lower extremity of the os femoris, require
the same treatment with fractures of its other parts.
[Illustration: _Plate 2._
_Tanner, Sc._]