The science and art of surgery : being a treatise on surgical injuries, diseases, and operations . caphoid articulation ; and if this bedone, disease will almost inevitably extend through the tarsal articula-tions. Excision of the astragalus alone, though sometimes required fordisease, is perhaps more frequently called for in those cases of compounddislocation in which the bone, having been thrown out of its bed, even-tually becomes carious or necroses. The operation of excision of the whole of the astragalus for diseasemay be done as follows. A curved incision, from four to six inches inlengt
The science and art of surgery : being a treatise on surgical injuries, diseases, and operations . caphoid articulation ; and if this bedone, disease will almost inevitably extend through the tarsal articula-tions. Excision of the astragalus alone, though sometimes required fordisease, is perhaps more frequently called for in those cases of compounddislocation in which the bone, having been thrown out of its bed, even-tually becomes carious or necroses. The operation of excision of the whole of the astragalus for diseasemay be done as follows. A curved incision, from four to six inches inlength, should be made immediately behind the outer malleolus, and car-ried forward on the outer part of the dorsum of the foot to opposite thefore part of the bone. The divisions of the external lateral ligament ofthe ankle-joint are then cut across; the tendons of the peroneus brevis?and tertius, and the extensor brevis digitorum muscle, divided. mass of extensor tendons in front of the foot, with the dorsalis pedisartery, must be left untouched. These should be drawn forcibly Fisf. 468.—Disease of Astragalus. EXCISION OF THE ASTRAGALUS. 281 The peronens longus tendon may be drawn backwards. The foot isthen strongly twisted inwards, the astragalus cleared, and its ligamentsdivided from the outer side in succession as they present the operation is done for disease of the bone, these structures willusually be more or less softened and disorganised ; wiien for injury,they will in a great measure have been torn through. Hence, in actualoperation, the same steps cannot be followed so methodically as may bedene on the dead subject. The hone must now be seized with lion-for-ceps and drawn well out of its bed; the knife being applied to any re-straining structure, but being used very carefully towards the inner sideof the bone, lest the {)lantar arteries be wounded. Under this processthe softened and carious bone usually breaks down and has to be taken
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