Landmarks, medical and surgical / by Luther Holden.

  • Luther Holden
Date:
1888
Catalogue details

Licence: Public Domain Mark

Credit: Landmarks, medical and surgical / by Luther Holden. Source: Wellcome Collection.

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    these pulleys the strongest is that of the extensor communis digitorum. When the ankle is sprained, the pain and swelling arise from a stretching of these pulleys and effusion into their synovial sheaths. A laceration of one of the pulleys and escape of the tendon is extremely rare. The place for the division of the tendon of the tibialis anticus, so as to divide it below its synovial sheath, is about one inch before its insertion into the cuneiform bone. The knife should be introduced on the outer side, so as to avoid the dorsal artery of the foot. Now trace the lines of the arteries, and the landmarks near which they divide. 144. Popliteal artery.—About one inch and a quarter below the head of the fibula, or say one inch below the tubercle of the tibia, the popliteal artery divides into the anterior and posterior tibial. The peroneal comes off from the posterior tibial about three inches below the head of the fibula. Consequently we may lay down, as a general rule, that, in amputations one inch below the head of the fibula, only one main artery, the popliteal, is divided. In amputations two inches below the head of the fibula, two main arteries, the anterior and posterior tibial, are divided. In amputations three inches below the head, three main arteries, the two tibials and the peroneal, are divided. 145. Anterior tibial artery.—The anterior tibial artery comes at first horizontally forwards between the bones to get to the front of the interosseous membrane, one inch and a quarter below the head of the fibula, and here lies close to this bone. Its subsequent course is defined by a line drawn from the front of the head of the fibula to the middle of the front of the ankle. This line corresponds pretty nearly with the outer border of the tibialis anticus all the way down. If this muscle be put in action, its outer border (the inter- muscular line) is plainly seen, and the incision for the ligature of the artery in any part of its course may be defined with the greatest precision. The artery can be felt beating and can be compressed where it crosses the front of the tibia and ankle.