Surgery, with Special Reference to PodiatryStern, Maximilian
Science
Surgery, with Special Reference to Podiatry
Stern, Maximilian
Foot -- Surgery; Surgery
The limb is wrapped with strips of sheet-wadding from the toes to the
middle of the thigh, and a circular plaster of Paris cast is applied
extending over the same area. Before the cast is dry, it is cut open
along the median line, in front, to allow for any swelling. The cast
is best applied while the patient is under the influence of an
anesthetic, so as to permit reduction of the fragments by traction
upon the foot. In from ten days to two weeks the cast should be
removed and a fresh one applied. The second cast does not require to
be cut open, and can be left on the limb until the end of the fourth
week. It is then removed and if union be complete, no further cast
need be worn. Massage of the limb and passive and active motion are
now begun.
+Fractures of the Tarsal Bones.+ Fractures of these bones have been
found far more frequently than was thought before the use of the
X-ray. Many cases of tarsal fracture have been treated for sprains of
the ankle. It is only when the recovery is slow or the injury is
followed by a traumatic flat foot that the surgeon begins to suspect
that a more serious condition was present at the time of the original
injury.
The astragalus and os calcis are the tarsal bones that are usually
affected. Fractures of the os calcis, in the majority of cases, are
due to compression. The patient falls from a height to the ground, on
a hard substance. The os calcis is crushed between the astragalus and
the ground.
There are three general types of fracture of the os calcis:
1. That in which the fracture has been confined largely to
that portion lying behind a vertical plane through the middle
of the body of the astragalus. There are three varieties of
this heel fragment type: (_a_) cases with one large heel
fragment; (_b_) cases of small heel fragments (in this
variety, also called avulsion fracture, the sudden contraction
of the calf muscles pulls the fragment off; at times the tendo
Achillis itself is torn off from the attachment to the os
calcis at the same time); (_c_) cases showing only fissures in
the bone.
2. Comminution of the anterior half of the os calcis.
3. All the cases of extensive comminution of the bones; the
bone is literally shattered.
+Fractures of the Astragalus.+ These can be divided into: (_a_) those of
the neck; (_b_) those of the body. The former are the most common
fractures of the astragalus. They may follow sudden dorsal flexion, or
forced supination, or pronation of the foot. They may be due to a fall
from a height or from direct violence. Fractures of the body of the
astragalus are usually the result of a crushing force which ordinarily
have a like effect on the body of the os calcis, and are often
associated with fractures of the latter bone. The variety of fractures
is considerable, varying from two large fragments, to complete
comminution of the bone.
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