1855 The Lancet  
This so-called ligament presenting the patella as a " sesamoid bone," developed in the tendon for the defence of the front of the knee-joint. The true ligaments within this joint being, on the other hand, -the crucial transverse and coronary inside, those on the posterior being the well known ligament of Winslow, the tendon of the popliteus, &c. This arrangement of the patella, extensor tendons, and parts inferiorly inserted, with a large bursa and mass of loose fat projecting into the cavity
more » ... g into the cavity of the joint below the patella, as well as the large pouch of synovial membrane immediately beneath the extensor tendon, and in front of the lower extremity of the femur, are all worthy of being kept in mind in considering the gravity of such an accident, which may, from external causes and mechanical injury, implicate all these parts, or the liga-mentum}!atella .alone, as in the present case. ST. BARTHOLOMEW'S HOSPITAL. (Under the care of Mr. M'WHINNIE,) JN connexion with a severe case of secondary haemorrhage given by Mr. Skey in extenso in T!IE LANCET of June 9th, the accompanying instance of rupture of the posterior tibial artery may be found instructive. In the following operation the artery was deligated without the surgeon being positively aware of the exact vessel torn, except from the presumptive evidence afforded by absence of pulsation, the excessive pain, and the nature of the accident, as -well as by the large quantity of blood thrown out from the artery; indeed, for some hours the question was in the balance as to whether the limb should be amputated, or the nature of the injury of the vessels in the ham ascertained first. The latter proceeding was, however, adopted, as not necessarily excluding the former, in case there should be necessity for it. The patient, too, was a brewer's drayman-a class who bear operations -very badly. R. S-, aged twenty-eight, was admitted into St. Bartholomew's Hospital, one day last month, in a state of great exhaustion. The history given of the accident was the following:—As he was driving his dray in the street, the horses started off, and his left leg got crushed between the front plank of the dray and a gate-post. The limb almost immediately began to swell; and, two hours after the accident, it was thought better to carry the man to the hospital. The limb was then swollen, tense, and cold, more especially below the knee, where the contrast as to cold was most marked, when com-
doi:10.1016/s0140-6736(02)53499-1 fatcat:vc6jdgugvrbvfekw3fxgaqxq44