eighbouring joint.

_Delayed union_ means that consolidation is taking place very slowly, if
at all. This may be due to local or constitutional causes, but provided
the bones are in good position, nothing further than patience, with
massage, and with due attention to general health-measures, is
necessary.

An _ununited fracture_ is one in which after many weeks or months no
attempt has been made by nature to consolidate the parts. This may be
due to the ends not having been brought close enough together; to the
seat of fracture having been constantly disturbed; to muscle or tendon
being interposed between the broken ends, or to the existence of some
constitutional defect in the patient. Except in the last-named
condition, the treatment consists in cutting down to the broken ends;
freshening them up by sawing off a thin slice, and by adjusting and
fixing them by a wire or screw. Ununited fracture of the leg-bones in
children is a most unsatisfactory and rebellious condition to deal with.

There is still a difference of opinion as to the best way of treating a
recent _fracture of the patella_ (knee-cap). Many surgeons are still
content to follow the old plan of fixing the limb on a back-splint, or
in plaster of Paris splints, and awaiting the result. It is beyond
question that a large percentage of these cases recover with a perfectly
useful limb--especially if the fibrous bond of union between the pieces
of the broken knee-cap is adequately protected against being stretched
by bending the leg at too early a date. But in some cases the fragments
have been eventually found wide apart, the patient being left with an
enfeebled limb. Still, at any rate, this line of treatment was
unassociated with risk. But after Lister showed (1883) that with due
care and cleanliness the knee-joint could be opened, and the fragments
of the broken patella secured in close apposition by a stout wire
suture, the treatment of the injury underwent a remarkable change. The
great advantage of Lister's treatment was that the fragments, being
fixed close together by the wire stitch, became solidly united by bone,
and the joint became as sound as it was before. Some surgeons, however,
objected to the operation--in spite of the excellence of the results
obtainable by it--because of the undoubted risk which it entailed of the
joint becoming invaded by septic micro-organisms. As a sort of
compromise, Professor A.E.J. Barker introduced the method, which