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.

    510/548 (page 498)
    identical with those above described, but are less marked. There is shortening of the foot, len,L;thening of the heel, and the projection of tlie end of the tibia on the dorsum of the foot. Dislocation forwards may be either complete or incomplete. When complete, the articular arch formed by the tibia and fibula rests on the superior surface of the jxisterior part of the oscalcisjust in front of tlie tendo Achilles, in the position risually occupied by a mass of fat.* Wlien incomplete, the anterior margin of this arch rests on the upper surface of the astragalus, somewhere near its posterior part, and may be fixed in this position, so that great difficulty is experienced in dislodging it, as in the case recorded by Mr. Poland, f The dislocation may take place witliout fracture either of the tibia or fibula. In Professor Smith's case alluded to above (page 490), the internal malleolus was broken off, but there was no fracture of the fibula. Symptoms.—The deformity produced by this dislocation is considerable; the piiucipal point whicli strikes the eye being an apparent elongation of the foot, and on actual measurement the distance from the instep to tlie toes along the dorsum of the foot will be found to be considerably increased ; tlie heel is less prominent and pointed than natural, and tlie space in front of the tendo Achilles is filled by a hard swelling, which is easily to be recognised as the lower end of the tibia and fibula with their malleoli. The tendo Achilles is not so prominent, and does not stand out in such relief as in tlie natural position of part.s. The displaced position of the malleoli at once establishes the diagnosis from transverse fracture of the lower end of the tibia or separation of its epipliysis. * See two cases, one recorded by Deiiiiirquay. J\[iinitcur des Srieiires Med., Oct. 1, ISOl; the other by'Willemiu, L'Union Midi- calf, ISGi). ■fUuy's Hosi)ital Reports, series iii., vol. i., p. 277; 1855.