. 11 Hinged splints or other special arrange ments Early movements and massage without reference to splints QUESTION 6.-In cases of fracture of the patella treated by wiring, when do you commence passive movement at the knee, and how long is it, as a rule, before the patients can return to their ordinary callings with free movement at the joint? LONDON.-Earliest period for commencement of passive movement, 'at once.' Latest period for commencement of passive movement, 21 days. Earliest period for walking with free movement, 3 weeks. Latest period for walking with free movement, 24 weeks. Date of commencement of passive movement— The remaining 10 per cent. commence movement—' after healing of wound,' 'when safe,' &c. Four surgeons prefer active movement to passive. Six use no splints after operation. The remainder use splints for periods varying from two days to six or eight weeks. PROVINCES.-Earliest period for commencement of passive movement, 'at once.' Latest period for commencement of passive movement, 12 weeks. Earliest period for walking with free movement, 3 weeks. Latest period for walking with free movement, 18 months. Date of commencement of passive movement— SCOTLAND AND IRELAND.-The replies are too few to justify general conclusions, but so far as they go, the following results are shown: Earliest period for passive movement, 4 days. Latest period for passive movement, 6 weeks. Latest period of recovery, 16 weeks. In Ireland the average period for recovery comes out at 9 weeks. In Scotland the average period for recovery comes out at 8 weeks. Speaking generally, taking the total replies into consideration, there is abundant evidence that the shortest periods of recovery follow in the cases in which passive or active movement is earliest used. QUESTION 7.-In cases of fracture of the patella treated by immediate suture, have you had any experience of results which are defective (e.g. with partial stiffness of the knee), or serious (e.g. terminating in amputation, in suppuration, or in complete stiffness at the knee)? 111 (one hundred and eleven) specific replies were received to this question, that is to say, from a large proportion of those surgeons giving information who operate in fracture of the patella. (See Question 5.) Of these-7 have had no unfavourable cases themselves, and make no mention of such in the practice of others. 14 have had no unfavourable cases themselves, 8 have in their own experience had to 1 mentions suppuration with great danger to life. 3 have had fatal results (one each). 2 make reference to (a) 'More than one fatal case in the practice of others,' and (b) 'Certain fatal cases.' 12 have experienced stiffness with material disability. 3 have seen failure of aseptic precautions followed by serious results.' 7 have seen stiffness without disability. 1 says the movements are never quite perfect. 5 have had experience of re-fracture or cutting through the bone by the wire during attempts at restoring movement, necessitating a second operation. 1 hesitates to answer the question without first consulting his solicitor. The remainder mention recurrent arthritis, necessitating removal of wire; results, 'No better than in cases not submitted to operation,' &c. Three surgeons have given up the operative treatment and have reverted to non-operative measures. QUESTION 8.-Have you had experience of the treatment of fractures by the immediate use of massage and passive movement; if so, what is your opinion of the method? Only 40 of those replying express a definite opinion upon this method In the above summary the percentages are as accurate as possible without the use of decimals. 1 This surgeon mentions a fatal case of embolism during the use of this treatment. (See remarks page 20.) 2 This opinion was subsequently modified. E |