Atlas and epitome of traumatic fractures and dislocations . the astragalus being driven against it. As a rule,a longitudinal fracture is found in the upper surface of thebone. In severe cases numerous additional lines of frac-ture are observed, so that the bone is literally a severe case the following characteristic symptoms arepresent : Thebone is enlargedin its lateral di-ameter, flattened,and painful. Themalleoli, espe-cially the inter-nal malleolus, arenearer the soleof the foot thanthey should be;pes planus is oftenpresent. Move-ment at the as-tragalo-cruraljoint is not af-f
Atlas and epitome of traumatic fractures and dislocations . the astragalus being driven against it. As a rule,a longitudinal fracture is found in the upper surface of thebone. In severe cases numerous additional lines of frac-ture are observed, so that the bone is literally a severe case the following characteristic symptoms arepresent : Thebone is enlargedin its lateral di-ameter, flattened,and painful. Themalleoli, espe-cially the inter-nal malleolus, arenearer the soleof the foot thanthey should be;pes planus is oftenpresent. Move-ment at the as-tragalo-cruraljoint is not af-fected, while themovement at thearticulation con-cerned in prona-tion and supina-tion of the foot islimited. Some-times the injuryis bilateral. In old casesthe diagnosis issometimes easier than in a recent case, on account of thecallus and secondary changes. In addition to the lateralenlargement of the os calcis which may reach 2 cm., thegrooves on either side of the tendo Achillis are obliteratedby edema ; the muscles of the calf are atrophied ; walking33. Fig. 154.—Typical compression-fracture of the OS calcis. Skiagraph. The alteration inthe shape of the anterior half of the bone isdistinctly shown; the distance between theupper and lower surfaces is shorter than nor-mal. Disability in this case was permanent. 338 FRACTURES AND DISLOCATIONS. is greatly interfered with; there is constant pain; andcharacteristic anomaUes in the position of the foot, withdepression of the malleoli, are noted. This fracture is much more common than was formerlysupposed. The injury is often mistaken for a severesprain. The most accurate examination is prognosis of this fracture is not very when it is recognized early, the functional use of thefoot is, as a rule, greatly impaired for some time. If the case is recognized verylate, the individuaPs abil-ity to earn his living maybe greatly diminished fora long time or even per-manently. This is nodoubt in part due to
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