.

[Illustration: FIG. 84.--Radiogram of Fracture of Head of Tibia and
Upper Third of Fibula.]

The ordinary clinical features of fracture are well marked, and the
diagnosis is easy. From some unexplained cause this fracture may take
a long time, sometimes several months, to consolidate.

#Separation of the upper epiphysis# of the tibia, which includes the
tongue-like process for the tubercle and the facet for the fibula, is
also rare. It usually occurs between the ages of three and nine. The
displacement of the epiphysis is almost always forward or lateral, and
is accompanied by the usual signs of such lesions. The growth of the
limb is sometimes arrested, and shortening and angular deformity may
result.

_Treatment._--After reduction under an anaesthetic these fractures are
usually satisfactorily treated in a box splint (Fig. 91), carried
sufficiently high to control the knee-joint. When the head of the
tibia is comminuted or split obliquely, weight-extension--direct from
the bone, the ice-tong callipers grasping the malleoli or the
calcaneus--may be used. Massage and movement are employed from the
outset.

Avulsion of the #tuberosity of the tibia# occasionally occurs in
youths, from violent contraction of the quadriceps--as in jumping. The
limb is at once rendered powerless; the osseous nodule can be felt,
and on moving it crepitus is elicited.

This is best treated by pegging the tuberosity in position, and fixing
the extended limb on an inclined plane to relax the quadriceps muscle.

In young, athletic subjects, the tongue-like process of the epiphysis
(Fig. 85), into which the ligamentum patellae is inserted, may be
partly or completely torn away, giving rise to localised swelling, and
pain which is aggravated by any muscular effort--_Schlatter's disease_
or "rugby knee." It has been frequently observed in cadets as a result
of kneeling at drill. The treatment consists in rest and massage, but
the symptoms are slow to disappear.

[Illustration: FIG. 85.--Radiogram illustrating Schlatter's disease.]

The condition is liable to be mistaken for some chronic inflammatory
condition of the bone, such as tubercle, unless an X-ray examination
is made.

The #upper end of the fibula# is seldom broken alone. The chief
clinical interest of this fracture lies in the fact that it may
implicate the common peroneal nerve, and cause drop-foot.

DISLOCATIONS OF THE KNEE

Dislocation of the knee is a rare injury, a