A manual of operative surgery . tain part of the inner surface can be reached from theposterior aspect. With care and patience and the use of good retractors the greaterpart of the bone can be bared through this outer incision, and fromthis side also the interosseous ligament can be reached and the os calcis is freed as far as possible, the head or anterior 760 OPERATIONS ON BONES AND JOINTS [part vii part must be grasped with lion forceps and the bone dragged outwardswith a repeated rotatory movement, the periosteum and ligamentsupon the inner surface being separated with the rug
A manual of operative surgery . tain part of the inner surface can be reached from theposterior aspect. With care and patience and the use of good retractors the greaterpart of the bone can be bared through this outer incision, and fromthis side also the interosseous ligament can be reached and the os calcis is freed as far as possible, the head or anterior 760 OPERATIONS ON BONES AND JOINTS [part vii part must be grasped with lion forceps and the bone dragged outwardswith a repeated rotatory movement, the periosteum and ligamentsupon the inner surface being separated with the rugine as soon aseach part of the as yet untouched district is reached. Comment.—This operation can be performed upon the cadaverin the systematic manner just described, but in practice so formal aprocedure can seldom be carried out. Sinuses may have to be considered, and carious and broken-downbone to be dealt with. A not inconsiderable part of the bone, in casesof disease, may be removed with the gouge or sharp spoon, and such. FIG. 479.—RESULT OF COMPLETE SUBPERIOSTEAL EXCISION OF THE RIGHT OS CALCIS. The bone has been so completely reproduced that there is a good heel. The foot is, however,shortened. The patient walked well. Note flexion of great toe due to interference withbony canal of flexor longus hallucis. parts of the compact tissue as are healthy may be left as a kind of thinosseous mould. The operations which are characterised by the formation of aU-shaped plantar flap are to be condemned, on account of the un-necessary damage they inflict upon the tissues of the sole. The foot must be fixed at a right angle with the leg, and the heelallowed to be free. An anterior well-moulded metal splint answers thepurpose well. After the splint has been applied, the limb must be sus-pended in a suitable apparatus. This protects the foot from anypressure, and allows efficient drainage to be carried out. As soon as possible a plaster-of-Paris case should be applied, asthen the pa
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