Throat Carriers in Midwifery Practice

Abstract

Warning against Excision of the Patella for Recurrent Dislocation SIR.-Recently Mr. Ralph Brooke published' 2 and showed the results of excision of the fractured patella. Since that time I have seen two cases in which different surgeons had removed the patella for recurrent dislocation. In each the symptoms of recurrent dislocation of the extensor apparatus continued after the operation. Case 1.-A maidservant, aged 23, had begun six years previouslv to suffer from attacks of locking of the left knee with outward displacement of the kneecap. The patella had been excised on this account thirteen months before I saw her. A month after operation the attacks of locking had returned, with all their previous characteristics, except that the patella itself was absent. Elmslie's operation of realignment of the extensor apparatus was performed five months ago, and there has been no recurrence of the symptoms since. Case 2.-A girl, aged 16, a leather worker, had first experienced giving way of the right knee, with locking, two years before. This had continued to happen about once a week, sometimes in bed, and she had discovered that the event was accompanied by outward displacement of the kneecap. Reduction would be achieved by a kicking movement. She had been treated at first with a walking caliper and later by excision of the patella. Six or seven weeks after the operation the symptoms had returned, attacks occurring with about the same frequency as before. Realignment of the extensor apparatus has been advised. Neither patient showed knock-knee or any radiological abnormality of the external femoral condyle. This note is written as a matter of urgency, in the hope that surgeons contemplating removal of the patella for recurrent dislocation will be dissuaded, and perform rather a physiological operation of realignment of the extensor apparatus on the lines of Elmslie's' operation.-I am, etc., H.