Wounds in war : the mechanism of their production and their treatment . y operation is required in allcases of severely comminuted and extensive gunshotfractures of the ankle, and more especially where theinjury to the tibia and fibula consists of fragmentationand prolonged fissuring into the shafts of the the tibia and fibula are uninjured, and the astra-galus and perhaps other of the tarsal bones only areimplicated in the fracture, the operation should be done AMPUTATION IN ANKLE CASES 215 at the joint, if the condition of the soft parts permit ofthis procedure. During the America
Wounds in war : the mechanism of their production and their treatment . y operation is required in allcases of severely comminuted and extensive gunshotfractures of the ankle, and more especially where theinjury to the tibia and fibula consists of fragmentationand prolonged fissuring into the shafts of the the tibia and fibula are uninjured, and the astra-galus and perhaps other of the tarsal bones only areimplicated in the fracture, the operation should be done AMPUTATION IN ANKLE CASES 215 at the joint, if the condition of the soft parts permit ofthis procedure. During the American War 161 amputations were per-formed at the ankle joint, with a mortality of per cent.,or per cent, less than that of amputation in the lowerthird of the leg. In the same war the secondary operationsgave a mortality of only per cent. Symes operation is the best method to employ, as itgives a better stump for the application of an artificial ap-paratus, and the method of performing it by peeling thesoft parts off the os calcis from above downwards, after. Fig. Suspension Splint for Gunshots of the Ankle. disarticulation of the ankle, is far easier than that usuallydescribed in text-books. Delorme suggests the propriety of amputation in caseswhere the lesser degrees of bone injury are accompaniedby destruction of the posterior tibial nerve. When thesoft parts about the joint are so much damaged thatefficient covering for an amputation at the ankle cannot beobtained, and when the ends of the tibia and fibula arecomminuted, the operation must be done in the leg ; butthe site of the section must be determined by the extentof fissuring, and no more should be removed than isnecessitated by this condition. 216 WOUNDS IN WAR Secondary Amputation is indicated when conserva-tive treatment has failed in consequence of infection of thejoint, and the patient is losing ground from suppurativearthritis and necrosis. The mortality, as above mentioned,is small. These op
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