Surgery, with Special Reference to PodiatryStern, Maximilian
Science
Surgery, with Special Reference to Podiatry
Stern, Maximilian
Foot -- Surgery; Surgery
+Fractures of the Lower Ends of the Tibia and Fibula.+ Commonly given
the name of _Pott’s Fracture_. They may be the result either of
forcible abduction or eversion of the foot, or of inversion or
adduction. If the sole or main movement is eversion, the _internal_
malleolus is broken, and if the force continues to act, it also causes
the _external_ malleolus to be broken. In the second variety, fracture
by inversion, the first effect of the force is to break the fibula at
the external malleolus. If the movement continues, the internal
malleolus or a greater portion of the tibia is broken off.
+Diagnosis.+ The diagnosis is usually easy to make. The ankle joint is
greatly swollen, the depression, normally present in front of and
behind the malleoli, being obliterated. The foot is displaced outward,
and the internal malleolus is prominent. This deformity will often
persist and become a cause of disability after healing of the
fracture.
There is also backward displacement of the foot. These displacements
may be so marked as, at first glance, to resemble a true dislocation
of the ankle.
Abnormal lateral and anteroposterior mobility may be ascertained by
grasping the sole of the foot with one hand and moving it inward and
outward, or backward and forward, while the other hand steadies the
leg. There is great tenderness between the tibia and fibula at the
front of the ankle, and over the points of fracture in the malleoli.
If the fibula alone be broken, abnormal mobility and crepitus may be
elicited by pressing its tip inward with the index finger of the one
hand while a finger of the other hand is placed at the seat of
fracture.
In some cases of Pott’s fracture the foot will move inward instead of
outward. The degree of outward displacement can be measured by the
difference in the distance from the front of the ankle to the cleft
between the first and second toes, as measured on the sound and
injured foot. There is not always complete loss of function. In
fractures of the external malleolus alone, the patient may walk quite
well.
+Treatment of Fractures of the Leg.+ The treatment of a simple fracture
of one or of both bones of the leg depends _first_, upon whether or
not swelling is present, and _second_, upon the amount of displacement
of fragments and our ability to keep them in apposition after
reduction. If the case is seen within a few hours after the injury and
but little, if any, swelling be present, the following is a perfectly
safe and justifiable method of treatment:
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