A practical treatise on fractures and dislocations . g lost its proper support, and not being of itselfcapable of steadily preserving its true perpendicular bearing, is forced offfrom the astragalus inward, by which means the weak bursal or commonligament of the joint is violently stretched, if not torn, and the strongones, which fasten the tibia to the astragalus and os calcis, are alwayslacerated; thus producing at the same time a perfect fracture and apartial dislocation, to which is sometimes added a wound in the integu-ments made by the bone at the inner Maisonneuve2 thinks he has
A practical treatise on fractures and dislocations . g lost its proper support, and not being of itselfcapable of steadily preserving its true perpendicular bearing, is forced offfrom the astragalus inward, by which means the weak bursal or commonligament of the joint is violently stretched, if not torn, and the strongones, which fasten the tibia to the astragalus and os calcis, are alwayslacerated; thus producing at the same time a perfect fracture and apartial dislocation, to which is sometimes added a wound in the integu-ments made by the bone at the inner Maisonneuve2 thinks he has established, by experiments upon the cadaver,that the fracture of the fibula at its lower extremity is caused not by forcedabduction of the foot, but by violent outward rotation; while M. Tillaux,3 bythe same mode of experimentation, has reached a different conclusion. Accord-ing to M. Tillaux, the first effect of the forced abduction is to tear the internallateral ligament, or to fracture the internal malleolus. The force, continuing to Fig. Mechanism of fracture of the lower end of fibula; A, parts in normal position; a, tibio-fibular ligaments; b, external lateral ligaments; >:, internal lateral ligaments. B, fractureof fibula due to eversion of the foot. C, fracture of the fibula due to inversion of the foot.(Treves.) operate in the same direction, presses the astragalus against the external malle-olus and tends to separate the fibula from the tibia, and may so far rupture theinferior peroneo-tibial ligament as to cause a diastasis of the articulation ; or aportion of the lower end of the tibia upon which the ligament is attached maybe torn off; or, the diastasis not having taken place, the fibula may break abovethe peroneo-tibial ligament. To this fracture M. Tillaux gives the name bi- 1 The Chirurgical Works of Percival Pott, , Surgeon to St. Bartholomews Amer. ed., 1819, p. 248. 2 Maisonneuve, Arch. Gen. de Med., fev. et avril, 1840. 3 Till
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