. On modern methods of treating fractures . bial operation, because the manipulationof the tibia is much easier when the fibula is freely sejDaratedinto two fragments. I do not think any elaborate operation is ever required. Asmall peg is jDcrhaps the most efficient method, but a plate orwire ^m\\ quite serve the purpose. FRACTURES IN THE NEIGHBOURHOOD OF THE ANKLE. It is neither j^ossible nor desirable to go into details aboutall the many varieties of fractures about the ankle-joint. Forthe present purpose it wall be sufficient to divide them intothose with no displacement—which need not be f
. On modern methods of treating fractures . bial operation, because the manipulationof the tibia is much easier when the fibula is freely sejDaratedinto two fragments. I do not think any elaborate operation is ever required. Asmall peg is jDcrhaps the most efficient method, but a plate orwire ^m\\ quite serve the purpose. FRACTURES IN THE NEIGHBOURHOOD OF THE ANKLE. It is neither j^ossible nor desirable to go into details aboutall the many varieties of fractures about the ankle-joint. Forthe present purpose it wall be sufficient to divide them intothose with no displacement—which need not be further discussedhere—and those with much displacement which will probably OPERATIVE TREATMENT OF SPECIAL FRACTURES 247 require operation. The second group may be subdivided intosupramalleolar, malleolar, fractures of the astragalus, and ofthe OS calcis. In the following sections it must be understoodthat I am only referring to cases in each group where thereis marked displacement which has not yielded to correctionunder an Fig. 124.—Malleolar fracture with marked displacement. Supramalleolar Fractures.—These fractures not only dis-organize the ankle-joint, but they are liable to produce adhesionsof the tendons running in front of the bones. The lower endsof the tibia and fibula are spongy bones which ^^^ll not holdscrews. Accurate reduction is often very difficult. Operation.—Double lateral incisions are required, but shouldbe curved, with convexity forwards, so that the sutured wounds 248 MODERN METHODS OF TREATING FRACTURES will not lie over the line of the ])lates. The lower ends of thetibia and fibula are first adjusted aecurately to one another inthose cases where they have been torn apart. Then the bonesare transfixed. It is safe to take a point 1 ineh above the tipof the internal malleolus and towards the back of the innersurface of the tibia. This will avoid anv danijer of enteringf the
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