. Text-book of operative surgery . rdin, in that we place it farther back, extend it higher up the limb, and carrythe curve down to the level of the astragalo-calcanean Joint, thus giving more room ARTHROTOMY, OSTEOTOMY, AND RESECTION 187 and allowing of the astragalus being excised if, as ofteii happens, the astragalo-calcaneanJoint is also diseased. Our incision is tlierefore analogous to the one first recom-mended by Albanese on Catterinas initiative, and later by Donenstein (Figs. 149, 150). The skin and fascia aie divided, while the externa! saphenons vein and nerve,which lie immediately
. Text-book of operative surgery . rdin, in that we place it farther back, extend it higher up the limb, and carrythe curve down to the level of the astragalo-calcanean Joint, thus giving more room ARTHROTOMY, OSTEOTOMY, AND RESECTION 187 and allowing of the astragalus being excised if, as ofteii happens, the astragalo-calcaneanJoint is also diseased. Our incision is tlierefore analogous to the one first recom-mended by Albanese on Catterinas initiative, and later by Donenstein (Figs. 149, 150). The skin and fascia aie divided, while the externa! saphenons vein and nerve,which lie immediately behind the incision, are jjreserved. Tlie incision terminates at the tendon of the peroneus tertius and avoids themusculo-cutaneous nerve. The sheaths of the peroneus longus and brevis are thenexposed and slit upwards behind the fibula as far as the upper end of the tendons have to be divided in some cases so as to afford more room, but each is Tendo Acliillis. Os calcis, Teudon peroneus brevis fc Tendon peroneus Outer licad sastrocnemras m. reroneus lonprus m. 2xt. long, digitorura m,Tibialis anticus brevis m. ( Tuberosity of ötli( nietatarsal. Fig. 149.—Tucisiou for artlirotoniy of ankle 011 riglit side. secured with silk in order to be sutured at a later stage. The periosteum is separatedfrom the outer and lower aspect of the external malleolus and the Joint opened intoin front of it. The capsule is now detached along the outer surface of the astragalus, exposingit as far as the fibula. The three bands of the external lateral ligament are dividedclose to their attachment to the tip and inner aspect of the external malleolus. The capsule, together with the periosteum, is separated from the anterior borderof the tibia as far as the internal malleolus, the extensor tendons being hookedupwards, a similar method being adopted at the posterior surface of the fibula so asto leave the tendon sheath of the peronei in relation to the periosteum. The fo
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