Manual of Surgery Volume Second: Extremities—Head—Neck. Sixth Edition.Thomson, Alexis
Science
Manual of Surgery Volume Second: Extremities—Head—Neck. Sixth Edition.
Thomson, Alexis
Surgery
Fractures of the tibia or fibula alone are treated on the same lines
as fractures of both bones, and splints are rarely necessary. The
ambulant method is useful in these cases (Fig. 95).
CHAPTER VIII
INJURIES IN REGION OF ANKLE AND FOOT
Surgical Anatomy--FRACTURES: _Pott's fracture_; _Converse of Pott's
fracture_; _Separation of lower epiphysis_; _Fracture of talus_;
_Fracture of calcaneus_; _Fractures of other tarsal bones_;
_Fractures of metatarsal bones_; _Fractures of
phalanges_--DISLOCATIONS: _Of ankle joint_; _Of inferior
tibio-fibular joint_; _Complete dislocation of talus_; _Sub-taloid
dislocation_; _Medio-tarsal dislocation_; _Tarso-metatarsal
dislocation_; _Dislocations of toes_.
The fractures in this region include Pott's fracture, and its
converse; separation of the lower epiphysis of the tibia; fractures of
the talus, calcaneus, and other tarsal bones; and fractures of the
metatarsals and phalanges. Various dislocations also occur, the most
important being those of the ankle joint, of the talus, and the
sub-taloid dislocation.
#Surgical Anatomy.#--For the study of injuries in the region of the
ankle-joint it is of importance to define the terms employed in
describing the movements of the foot. Thus by _flexion_ or
_dorsiflexion_ is meant that movement which approximates the dorsum of
the foot to the front of the leg; while _extension_ or _plantar
flexion_ means the drawing up of the heel so that the toes are
pointed. In _inversion_ the medial edge of the foot is drawn up so
that the sole looks towards the middle line of the body, an attitude
which is analogous to supination of the hand. In _eversion_ the
lateral edge of the foot is drawn up, the sole looking away from the
middle line--analogous to pronation of the hand. _Adduction_ indicates
the rotation of the foot so that the toes are turned towards the
middle line of the body; while in _abduction_ the toes are turned away
from the middle line.
The most prominent bony landmarks in the region of the ankle are the
two _malleoli_, the lateral lying slightly farther back, and about
half an inch lower than the medial. On the medial side of the foot
from behind forward may be felt the _medial process (internal
tuberosity)_ of the calcaneus; the _sustentaculum tali_, which lies
about 1 inch vertically below the tip of the malleolus; the _tubercle
of the navicular_, about 1 inch in front of the malleolus, and at a
slightly lower level; the _first (internal) cuneiform_, and the base,
shaft, and head of the _first metatarsal_.
On the lateral side may be recognised the _lateral process (external
tuberosity)_ of the calcaneus; the _trochlear process (peroneal
tubercle)_ on the same bone; the _cuboid_; and the prominent base of
the _fifth metatarsal_.
The talo-navicular joint lies immediately behind the tuberosity of the
navicular, and a line drawn straight across the foot at this level
passes over the calcaneo-cuboid joint.
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