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1947 by Boston, American Orthopaedic Association
J Bone Joint Surg Am, 1947 Jul 01;29(3):679-686
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1. Evidence has been produced to show that adhesions in the quadriceps may be the primary cause of knee stiffness after fractures of the shaft of the femur.

2. The recovery of perfect knee movement after a fracture of the shaft of the femur depends upon the complete absorptin of scar tissue involving muscle at the fracture site.

3. The production of scar tissue around a fracture and the involvement of the surrounding muscles is a biological process, related to the healing power of the fracture and unrelated to early mechanical knee motion.

4. If the fracture of the femur shows clinical union in eight weeks, final knee motion will he excellent even if the knee remains fixed throughout treatment. Scar tissue in these cases is minimum, and bony callus is plentiful.

5. If the fracture of the femur shows delayed union, it is doubtful whether mechanical knee movement will prevent considerable permanent knee stiffness. In these cases, bony callus is scanty, permanent scar tissue is plentiful, and quadriceps tethering occurs.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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