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ments. Its general direction was first from above downward and outward, then from above downward and inward, the two lines including a large wedge-shaped piece of bone, measuring can i buy strattera online three inches in cheaper alternatives to strattera length on its longest side, and including at its apex nearly the whole of the diameter of the bone. This, to- gether with two smaller fragments, was found to be so complete- ly isolated from all vascular supply that its removal from the wound was rendered necessary ; in fact, the large fragment was turned upon itself so as to strattera costs without insurance occupy an antero-posterior position with regard to the long axis of the tibia, while one of its sharp points had seriously lacerated the deep muscles of the leg and was lying in dangerously close proximity to the posterior tibial artery. Deep pockets, filled with clotted blood and reaching for two or three inches above and below the wound, were ex- posed and cleansed. The main fragments were then drilled in two places and brought together with heavy silver wire; the wound closed and drained through one of the bone punctures; the limb dressed antiseptically, and put up like the others. The patient had no symptoms worthy of note. Dressings changed on the twelfth day, and the wound found healed; tube removed and limb redressed. August 1st. — Plaster splint applied. Patient still under treatment. Through the courtesy of Dr. L. W. Hubbard, formerly house surgeon to Belle vue Hospital, I am accorded cheapest strattera the privilege of bringing to the notice of the society the promi- nent features of one of the most interesting and instructive cases of this kind which have ever fallen under my obser- vation. This case, in which I had the pleasure of assisting Dr. Hubbard, will be reported in full in the " New York Medi- strattera price australia cal Journal " in connection with my own.* Case I. — Fracture of the Patella. — Henry Vilner, Hebrew, peddler, aged twenty-four; feeble health, badly nourished. June 9, 1883. — Patient was knocked down in the street to- day and sustained a transverse fracture of strattera 25 mg street price the right patella. When admitted to the hospital there was a large effusion of blood into the joint, with great swelling and ecchymosis. The frag- ments of bone were buy strattera online cheap separated about three inches, and it was im- possible to approximate them at any time. He was treated with cold applications, ice to the joint, position, cheap generic strattera and various forms of apparatus without benefit until July l'3th, when the joint was opened, under irrigation, by strattera 40 mg street price a crucial incision, and thoroughly cleaned out. The fractured surfaces were then scraped, the fragments drilled and wired, and the joint drained. The wound was then closed with a continuous suture of carbolized catgut, the limb dressed antisei)tically, and the knee joint immobilized. The o|)eration was followed by some sloughing of tho edges of the skin-wound and hy the formation of a circuin-articular ab- scess ; but all eventually repaired, and the patient was dis- charged, October 1st (sixteen weeks after the injury), with bony union of the patella, able to walk well, and with about twenty degrees of motion in the joint. Brief lilstory of case given. Oct. 31, 1885.] HUBBARD: COMPOUND FRACTURE OF THE TIBIA TREATED BY WIRING. 479 Patient seen eighteen months after the injury, with cheapest price strattera fnll mo- tion of the joint, with perfect bony union of fragments, and he stated that he had walked twenty miles the day before without inconvenience and without artificial support of any kind. Casb it. cheaper alternative strattera — Fracture of the Patella. — James Klein, German baker, aged forty-five ; healthy. January 9, 1885. — Fell in the street to-day, striking the bent right knee on a stone and fracturing the patella trans- versely. The joint was greatly distended with blood and very painful. I was unable to determine the exact nature of the fracture on account strattera cost 40 mg of swelling and effusion. The limb was suspended and treated with cold applications. February 2d. — Knee still very much swollen, hot, tender, and painful, and I fear a suppurative inflammation of the joint. Opened joint, under irrigation, by a crucial incision. The capsule of the joint and the aponeurotic structures were all extensively lacerated, with their ragged edges turned into the cavity of the joint. The patella was fractured much does strattera cost canada transversely about its middle, with the upper fragment split longitudinally into two portions, but not entirely separated from each other, while three smaller fragments were found loose in the joint. The cavity of the joint was enormously distended with clots, in which the main fragments were deeply buried. The joint was thoroughly cleaned, the fragments drilled and wired in two places; the capsule and aponeurosis trimmed and sewed up with fine catgut; the skin-wounds closed separately in the same way, and the joint drained. Antiseptic dressings were then applied, and the limb suspended in a wire cradle. H^th. — First dressing (twelve days); wound healed; no fluid in the joint; tubes removed and new dressings applied. High- est temperature since the operation, 1002°. 2Sth. — Fragments in good position and strattera prescription price get strattera cheaper apparently united; applied plaster splint. Discharged about the middle of March. April 22d (twelve weeks after injury). — Can bend knee to right angle, and union cheapest place buy strattera seems to be perfect. Walked ten miles with cane two days ago. Case III. — Fracture of the Patella. — J. II., laborer, Ameri- can, aged thirty-three, healthy. June 10, 188.5. — Six months ago patient was thrown from a wagon and sustained a transverse fracture of the right patella. The knee joint is now nearly order strattera online canada useless; the fragments are three inches apart, and apparently held together do you need prescription strattera by a very thin fibrous band. Joint opened under irrigation ; the fractured surfaces freshened, and the fragments drilled in two places, wired, and the limb put up like the others. The patient had cheapest strattera online no constitu- tional disturbance whatever as a result of the operation. At the end of ten days the wound was dressed and found healed throughout ;
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