11. Many authors have pretended that fractures of the rotula cannot
be cured, and it even appears that the Academy of Surgery adopted
this opinion, on receiving a memoir from a Flemish physician, which
contained several facts tending to establish that principle. But what
do these facts prove? That in some particular cases, reunion did not
take place, but they do not show that this was owing to the nature of
the fracture.
12. But, what, in such cases, could prevent a cure from taking place?
The structure of the rotula differs, say they, from that of the other
bones. Now, admitting this difference of structure to be real, it
certainly approaches to the structure of tendons to which indeed it
bears a strong affinity. But, who does not know, that, when tendons are
divided, they unite as readily as bones? Besides, is not the power of
reunion common to every part endowed with life? I have already shown,
when treating of other fractures that communicate with joints, what
credit is due to those hypotheses so often revived but never confirmed,
nay even clearly proved to be unfounded, such as, an effusion of callus
into the joint, a failure of reunion from a want of periosteum on the
posterior part of the bone, the synovia diluting the matter of callus,
and thus preventing it from being duly prepared, &c.
13. The inflammation of the articulating surfaces and of the ligaments
around the joint, ought to have more influence in constituting an
unfavourable prognosis, than any circumstance that authors have
mentioned. But experience proves, that, when judiciously treated, these
fractures are not accompanied by that accident, and even that the
swelling, which for the most part attends them, always yields more or
less speedily, when a bandage, uniformly applied, presses equally on
all parts around the joint, and thus forms a kind of discutient, while
at the same time it retains the fragments.
14. Pare, Fabricius of Hilden, and a number of other writers, have
pretended, that some degree of lameness must always be the consequence
of this fracture. But, from what causes must this lameness so certainly
arise? Is it from a want of reunion in the part? I have already shown
(11 and 12) that this apprehension is wholly unfounded. Is it from
an anchylosis? This accident cannot take place, except either in
consequence of inflammation occurring in the articulating surfaces,
(and I have already shown how that may be avoided, 13) or of a
stiffness in the ligaments, and I shall hereafter make it appear that
that may be readily prevented by motion. Is it from the fragments being
drawn asunder, and in that state united by an intermediate substance
of too great an extent? I shall prove, that a bandage properly
constructed, is always sufficient to keep these fragments in contact.
From these considerations it appears, that writers have, in general,
without sufficient cause, given an unfavourable prognosis, in relation
to fractures of the rotula, which have, indeed, a great affinity to
other affections of the same kind.
§ V.