Step 2. They should then be fastened by figure of 8 round the foot and ankle until the foot is securely fixed in them. The bandage should then be fastened off, and extension made by an assistant, who grasps the foot and ankle with both hands while the surgeon fixes the splints to the limb above the fracture, beginning his roller at the top just below the knee, and continuing it downwards with spiral turns until the fracture is reached, above which it should terminate (fig. 45). After the apparatus is applied, the limb may be either supported upright by sand-bags, or slung in a cradle, for three weeks, after which the splints are advantageously replaced by a starch bandage for three weeks longer. [Illustration: Fig. 45.—Lateral Splints for simple transverse fracture of the Tibia.] _Flexing the Leg for Fracture of the Tibia._ Sometimes, when there is unusual difficulty in preventing displacement of the fragments while the limb is nearly straight, the bones can be readily kept in position if the patient lies on the same side as the injured limb and the knee is well flexed. For such cases these splints are very suitable; they should be applied after the limb has been bent and the fragments brought into apposition. When the splints have been put on, a roller may be carried round the leg and thigh to keep the limb in its bent position. =Fracture of the Patella.=—When this bone is broken there is usually much swelling from effusion into the knee-joint; while this is present, rest, with cold lotions, and elevation of the foot, are alone applicable. When the effusion has subsided, the upper fragment must be brought down to the lower one, by some means like the following. _Apparatus._—1. Straight wooden splint with a foot-piece. 2. Pads. 3. Diachylon plaster. 4. Roller. 5. Lint and wool. 6. Two hooks or screws, gimlet, and screw-driver. Step 1. The splint is first fitted; it should reach from the buttock to the heel, at which point a foot-piece rises for the foot to rest against; at the back of the splint a line should be marked 3 inches above, and another 3 inches below the knee-cap, into which a stout screw or hook is inserted before the splint is put on. It is then well padded, to support the calf and leg, while the heel is left free, and a pad is put between the sole and the foot-piece. A firm crescent-shaped pad is prepared to sit like a saddle above the upper fragment. Step 2. The limb is laid on the splint; an assistant draws the patella as nearly as possible into its place, and the surgeon lays the crescentic pad on the thigh above the patella, and takes a strap of plaster 2 inches broad and 20 long, warms it, and lays the middle across the compress, drawing each end tightly around the limb, and then downwards and forwards in a figure of 8; a similar strap is then fixed below the lower fragment. The knee, shin, ankle, and foot are then protected by a layer of cotton wool, and the bandaging begins.