Fractures and dislocations / by T. Pickering Pick.

  • Thomas Pickering Pick
Date:
1885
Catalogue details

Licence: Public Domain Mark

Credit: Fractures and dislocations / by T. Pickering Pick. Source: Wellcome Collection.

    506/548 (page 494)
    inner extremity of the arcli, or upon the lower end of the fractured shaft of the tibia, from which the internal malleolus has been separated. The causes which produce this dislocation are tlie same as those whicli cause the displacenient outwards, viz. violent twists or strains of the foot; but the force is applied in the opposite direction, so as to turn the foot inwards. The violence required to produce the dislocation is, however, much greater, and the tibia being a far stronger bone than the fibula, the accident less frecjuently takes place. The symptoms are the same, miUatis miitcmdis, as in dislocation outwards. There is inversion of the foot, so that its outer edge rests on the ground, the sole looks upwards and in- wards, and the inner border is elevated. The ex- ternal malleolus projects on tlie outer side of the ankle, beneath the skin, which is tense and stretched over it, and almost touches the ground. When the patient is in the erect position, there is a distinct de- jiression on the inner side of the joint, corresponding to the fracture of tlie tibia, and crepitus, as a rule, is easily felt. Treatiueut of lateral displacesneut.—In the majority of cases reduction can be accomplished without difficulty; sometimes, however, on the other hand, the greatest difficulty will be experienced, not only in effi^^eting reduction, but also afterwards in main- taining the bones in accurate position. The mode of jiroceeding is first of all to flex the leg on the thigh and the thigh on the pelvis, in order to relax as much as ■ possible the muscular structures, and then, an assis- tant grasjjing the leg near the knee, in order to make counter-extension, the surgeon seizes the foot with one hand over the point of the heel and the other over the dorsum of the fool, and makes steady traction directly downwards. He at the same time, by a lateral movement of the hands, conveys a gentle rocking