. The principles and practice of surgery. m, astragalus, scaphoid, and cuboid. I have met withnecrosis most often in the cuneiform bones, ensuing usually upon gun-shot and other injuries of the lower portion of the foot, and as a con- 1 Rogers. Case of Excision of the entire Scapula, with a History of the Operation*involving the Removal of all, or a considerable Part, of this Bone. Amer. Journ. , Oct., 1808. 396 EXCISIONS OF THE FOOT. sequence of the extension of inflammation with, suppuration along theircommon synovial surfaces. The anatomy of the synovial sacs of the tarsal articulat
. The principles and practice of surgery. m, astragalus, scaphoid, and cuboid. I have met withnecrosis most often in the cuneiform bones, ensuing usually upon gun-shot and other injuries of the lower portion of the foot, and as a con- 1 Rogers. Case of Excision of the entire Scapula, with a History of the Operation*involving the Removal of all, or a considerable Part, of this Bone. Amer. Journ. , Oct., 1808. 396 EXCISIONS OF THE FOOT. sequence of the extension of inflammation with, suppuration along theircommon synovial surfaces. The anatomy of the synovial sacs of the tarsal articulations will ex-plain the limitation of primary disease in the case of certain tarsalbones, and its tendency to extend in the case of certain other tarsalbones. There are four distinct synovial sacs composing the tarsal articula-tions, namely: first, the posterior calcaneo-astragaloid; second, theanterior calcaneo-astragaloid, and the astragalo-scaphoid; third, thecalcaneo-cuboid; and fourth, a synovial sac which is continuous be- Fig. Anatomy of Tarsal Synovial Sacs. tween the scaphoid and three cuneiform, between the cuneiform indi-vidually, between the external cuneiform and the cuboid, and betweenthe middle and external cuneiform on the one hand, and the corre-sponding metatarsal, bones on the other. More or less, also, this lattercavity is prolonged between certain metatarsal bones. We shall observe, therefore, that disease of the first synovial sac is lia-ble only to implicate the astragalus and calcaneum posteriorly; diseaseof the second may directly involve the anterior portions of the astraga-lus, calcaneum, and the scaphoid; disease of the third is likely to belimited to the calcaneum and cuboid; while disease of the fourth mayrapidly and consecutively involve the cuneiform, cuboid, scaphoid,and even the metatarsal bones. But primary disease of each individual bone is propagated chiefly toother bones through these synovial membranes; consequently diseaseof the calc
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