Fractured Patella.—In this case care must be taken not to draw the fragments apart, or to stretch the connecting fibres while striving by manipulations to prevent adhesion of the patella to the femur.

The fragments should be held in position by one thumb and index-finger being placed on the upper and lower borders, while the work round the patella is done with the other thumb and fingers.

Friction and gentle effleurage may be used all about the joint, and, as in all fractures and sprains, the muscles above and below the seat of fracture are stroked and kneaded to keep them from wasting. When effusion and inflammation have subsided, gentle movement to the joint may be commenced. If the bone has been wired the work is the same, but naturally there is less anxiety as to the separation of the fragments.