To effect reduction, the quadriceps must be thoroughly relaxed by extending the leg upon the thigh and flexing the thigh upon the pelvis; the patella is then tilted by making firm pressure on that edge which lies farthest from the middle of the joint, and at the same time pushing towards the middle line. The limb is placed on a posterior splint, and firm elastic pressure made on the joint to prevent or diminish effusion. Massage and movement are carried out from the first. As the displacement is liable to recur, the patient should wear a firm elastic bandage or a strong knee-cap. _Permanent and recurrent dislocation of the patella_ will be described later. FRACTURE OF THE BONES OF THE LEG The bones of the leg may be broken together or separately. #Fracture of both Bones.#--The features of this injury depend to a large extent upon the nature of the violence producing it. In fracture by _direct_ violence, such as the passage of a wheel over the limb or a severe blow, the bones give way at the point of impact, and the line of fracture tends to be transverse, both bones being broken at the same level (Fig. 89). There is little or no displacement, and such as there is is angular, and is determined by the direction of the fracturing force. [Illustration: FIG. 89.--Radiogram of Transverse Fracture of both Bones of Leg by direct violence.] When the violence is _indirect_, as from a fall on the feet, or a twist of the leg, the tibia usually gives way at the junction of its lower and middle thirds, and the fibula at a higher level (Fig. 90). Torsion of the tibia is probably the most important factor in the production of the fracture, the distal fragment being fixed by the pressure of the foot upon the ground, while the proximal fragment is rotated by the impetus of the body. Both fractures are usually oblique--that in the tibia running from above downward, forward, and medially, and it is generally found that the obliquity of the fibular fracture corresponds with that in the tibia. [Illustration: FIG. 90.--Radiogram of Oblique Fracture of both Bones of Leg by indirect violence.] There is usually considerable displacement, the weight of the lower portion of the limb causing it to fall backwards and to roll away from the middle line, and the traction of the calf muscles pulling up the heel and pointing the toes. The proximal fragment forms a projection on the front of the limb.