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.

    519/548 (page 507)
    any siiilden %'iolence these ligaments are torn, the astragalus would be shot out backwards, and the inter- osseous and other ligaments connecting it to the other tarsal bones being ruptured, dislocation would result. The fact that displacement backwards is likely to occur when the foot is flexed at the ankle joint is rendered probable by a case recoi'ded by Mr. Benjamin Phillips, where a gentleman, in running, placed his foot in a gutter, so that the toes rested on the farther edge and his heel was jammed violently down to the bottom of the gutter, the patient at the same time falling forwards.* Symptoms.—In these cases there is not the same striking deformity as in the forward displace- ment. There is generally no eversion or inversion of the foot. The most marked sign is the presence of a hard prominence just above the heel, between the tendo Achilles and the malleoli; sometimes projecting beyond the heel, so that the tendon is pushed out of position and presents a convex outline. In those cases where the bone is displaced obliquely, the astragalus projects to one or other side under the skin, which is tightly stretched over it, so that its various articulating surfaces can usually be made out -svith the exception of the head, which remains buried under the tibia The anterior border of the inferior ex- tremity of this bone can generally be felt on the front of the joint, with a hollow or depression in front of it, from which the tibia has been removed. The move- ments of the ankle joint are lost. JLatcral dislocations of the astragalus.— Many of the cases which have been described as lateral dislocations of the astragalus ought, no doubt, to have been more correctly dcsci-ibed as oblique di.slocation forwards and outwards or forwards and inwards; but, nevertheless, true direct displacement * Medical Gazette, vol. xiv. ; 1834.