Surgery; its theory and practice . head of fractureof the fibula (see p. 456.) The back-ward and forward varieties are rare;the latter especially so. In the former(Fig. 188), the astragalus is either par-tially or completely driven backwardsfrom its socket, carrying with it, ofcourse, the other bones of the foot; sothat the foot appears shortened, theheel prominent, and the tendo Achillistense. In the forward variety theastragalus is generally forced only par-tially from between the malleoli, andthe foot appears lengthened, the heelless prominent than natural, and thetendo Achillis relaxed. In
Surgery; its theory and practice . head of fractureof the fibula (see p. 456.) The back-ward and forward varieties are rare;the latter especially so. In the former(Fig. 188), the astragalus is either par-tially or completely driven backwardsfrom its socket, carrying with it, ofcourse, the other bones of the foot; sothat the foot appears shortened, theheel prominent, and the tendo Achillistense. In the forward variety theastragalus is generally forced only par-tially from between the malleoli, andthe foot appears lengthened, the heelless prominent than natural, and thetendo Achillis relaxed. In the upivardvariety the tibia and fibula are tornasunder, and the astragalus is forcedupwards between them. ]he ankleappears widened, the malleoli are almost in contact with theground, and all motion at the ankle-joint is lost. Treatment.—The leg having been flexed and the foot extended to relax thecalf-muscles, make extension on the foot whilst an assistant holdsthe thigh, and then manipulate the bones into position. If neces-. Dislocation of the foot Bartholomews HospitalMuseum.) THE SUBASTRAGALOID DISLOCATION. 443 sary, give an anaesthetic, and cut the tendo Achillis. Place thefoot and leg on a back-splint, or, if preferred, on a Chnes orDupuytrens splint. Compound dislocation of the ankle.—In young and healthysubjects an attempt should be made to save the foot, unless themain vessels are torn, or there is much comminution of the bones,or extensive laceration of the soft parts, when amputation is thesafer course. Resection of the bones, however, may, in someinstances, be undertaken with advantage ; but each case must bejudged on its merits, and the indications for resection cannot bediscussed here. The astragalus may be dislocated from the tibia and fibulaabove and from the os calcis and scaphoid below and in front, ina forward, backward, inward or outward direction; whilst veryrarely it may be rotated on its own axis either vertically or hori-zontally. Th
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Keywords: ., bookcentury1800, bookdecade1890, booksubjectsurgery, bookyear1896
