A fracture of the ankle joint is really a fracture of the lower extremities of the bones of the leg. There are present pain and great swelling, particularly on the inner side of the ankle at first, and the whole foot is pushed and bent outward. The bony prominence on the inner side of the ankle is unduly marked. The foot besides being bent outward is also displaced backward on the leg. This fracture might be taken for a dislocation or sprain of the ankle. Dislocation of the ankle without fracture is very rare, and when the foot is returned to its proper position it will stay there, while in fracture the foot drops back to its former displaced state. In sprained ankle there are pain and swelling, but not the deformity caused by the displacement of the foot. This fracture may be treated temporarily by returning the foot to its usual position and putting on side splints and a back splint, as described for the treatment of fracture of the leg. =COMPOUND OR OPEN FRACTURE OF THE LEG.=--This condition may be produced either by the violence which caused the fracture also leading to destruction of the skin and soft parts beneath, or by the end of a bony fragment piercing the muscles and skin from within. In either event the result is much more serious than that of an ordinary simple fracture, for germs can gain entrance through the wound in the skin and cause inflammation with partial destruction or death of the part. =Treatment.=--Immediate treatment is here of the utmost value. It is applicable to open or compound fracture in any part of the body. The area for a considerable distance about the wound, if covered with hair, should be shaved. It should then be washed with warm water and soap by means of a clean piece of cotton cloth or absorbent cotton. Then some absorbent cotton or cotton cloth should be boiled in water in a clean vessel for a few minutes, and, after the operator has thoroughly washed his hands, the boiled water (when sufficiently cool) should be applied to the wounded area and surrounding parts with the boiled cotton, removing in the most painstaking way all visible and invisible dirt. By allowing some of the water to flow over the wound from the height of a few feet this result is favored. Finally some of the boiled cotton, which has not been previously touched, is spread over the wound wet, and covered with clean, dry cotton and bandaged. Splints are then applied as for simple fracture in the same locality (p. 113). If a fragment of bone projects through the wound it may be replaced after the cleansing just described, by grasping the lower part of the limb and pulling in a straight line of the limb away from the body, while an assistant holds firmly the upper part of the limb and pulls in the opposite direction. During the whole process neither the hands of the operator nor the boiled cotton should come in contact with anything except the vessel containing the boiled water and the patient. FOOTNOTES: