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stairs ; it was possible for him to walk on the level. Why he could not walk when the knee splints were off was not easy to explain. It might have been on account of the sense of insecurity, or from the fear of falling, consequent upon the derangement of the neuro-muscular apparatus of each knee joint at the same time. From all that I could bring to bear on the premises out of which to draw a conclusion, I could only make an unfavorable statement in regard to the disability of this man's power of locomotion. He is destined to be a cripple during the rest of Ids life. His disability is very great. If we take this case as a basis for judging, we must conclude that the prognosis, in a case of double fracture of the pa- tella, is very unfavorable in respect to the future use buy cheap praziquantel of the lower limbs. In this place we may briefly consider a few points in regard to the mechanics of the knee joint, since some light may thereby be shed on the extraordinary disability follow- ing a double fracture of the patellae. The lower surface of the patella presents about two square inches of surface to the femoral condyles ; the extent of this surface, however, varies in different cases ; I have seen it as much as two inches square. This surface, as the patella moves where to buy praziquantel under the pull of the quadriceps extensor, makes an equal pressure on the femoral condyles at all points of contact, during flexion and extension of the leg in the act of locomotion. Now, in order to purchase praziquantel lift the weight of the body of an average-sized man, under ordinary conditions, with the quadriceps extensor and the femoral lever, the pressure of the patella on the femoral condyles will be anywhere from 500 to 1,500 pounds avoir- dupois. But when the body, under certain other conditions, acquires considerable momentum, the pressure of the patella on the femoral condyles may be much greater than this esti- mate. On the basis of these facts we can readily see the importance of the patella in praziquantel cost the act of locomotion, especially in going up and down stairs, for, if we suppose the patella to be very much smaller thau it is, or that the tendon of the quadriceps extensor had no sesamoid bone, we would have 542 WIGHT: praziquantel biltricide TEE DISABILITY praziquantel tablets IN FRACTURES OF THE PATELLA. [N. Y. Med. Jock, undue pressure at one point, or in one line, on the femoral condyles, and the effect might he imagined when we remem- ber that a cubic inch of cancellous bone will only sustain a pressure of about 600 pounds avoirdupois. In fact, there would be serious damage to the femoral condyles under the supposed conditions. As a corroborating fact, we may men- tion that the patella is sometimes turned upon its edge — a kind of dislocation — and, by the force of the quadriceps ex- tensor, is so firmly driven into the cancellous tissue of the femoral condyles as to prevent surgical skill from detaching it and restoring it to its normal position. In praziquantel mg the mean time it must be kept in mind that the patella projects with- in the knee joint about one fourth of an inch beyond the tendon in which it is an essential part, and order praziquantel online that as the pa- tella, with its ligament and tendon, moves in the act of loco- motion around the condyloid curve of the femur, the greater stress, and sometimes the greater strain, is, from the me- chanical conditions, put on the more anterior and superficial patellar structures ; and that the patella, when in the power- ful grasp of the quadriceps extensor, consequent on slip- ping and trying to prevent a fall, has its anterior fibers put under stress order praziquantel and strain mostly at first, and has these fibers broken first in order — when the fracture extends at once backward through the entire bone. And, moreover, it can readily be praziquantel online demonstrated that the tendinous and fascial structures — as they are expanded purchase praziquantel online in front of the lower end of the femur — converge, generic praziquantel as it were, toward the patella from both sides of the limb, and are thus kept in an expanded form over the femoral condyles as the leg is flexed ; and, during the flexion and extension of the leg, the tendo-patella and the adjacent buy praziquantel fascial and capsular structures are continuously and accurately applied to the uneven surface of the anterior aspect of buy praziquantel online the condyloid end of buy praziquantel for humans the femur in the most admirable manner, so that, when the leg is much flexed on the thigh, and when more force is required to lift and lower the praziquantel price weight of the body, a very much greater surface of the femoral condyles receives the pressure, and hence the condyloid cancellous tissue in actual use is proportioned to the amount of work to be done, andis therefore conserved in its integrity durimr locomotion. And, when the patella is fractured, the integrity of the tibio-fcmoral and the patello-femoral — or, collectively, the knee joint — is more or less seriously damaged in three direc- tions: (1) The relations of the fibers converging to the pa- tella may be materially deranged; (2) the angle of the liga- mentuin patelhc and the upper end of the tibia is made less ; (3) the joint-surface moxidectin praziquantel of the patella is more or less praziquantel uk deformed ; that is, the functions of the neuro-muscular apparatus are more or less materially impaired. And so, if the sense of security possessed by a patient under ordinary conditions of praziquantel 600 mg locomotion may be greatly disturbed by a single fracture of the patella, it would be very greatly disturbed by a double fracture of the patclhe. Now, while it might seem that such a case as above de- scribed ought not to result in so much disability, yet, when we come to consider all the mechanical relations of the knee joint, and when we come to consider the results of a few

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