Licence: Public Domain Mark
Credit: Fractures and dislocations. Source: Wellcome Collection.
Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.
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![Bryant has recorded two cases, one occurring in his own ]>ractice, the other in tliat of Mr. Cock ; the difficulty was at once overcome by the division of the tendo Achilles. Dislocation upwards.—In this form of dis- placement the inferior tibio-fibular ligaments are said to be ruptured, the tibia and fibula to be widely separated from each other, and the upper articular portion of the astragalus forced up between the two bones. It would scarcely seem possible for such an accident to take place, considering the strength of the ligaments ; for not only must the inferior tibio-fibular ligaments be torn, but also probably the interosseous membrane and the strong lateral ligaments of the ankle joint, to allow such a displacement to take place. It would seem more than probable that the bones would scarcely withstand such violence as would be necessaiy to produce such a lesion, but that the bones themselves would break before the ligaments would yield. Nevertheless, cases have been recorded which leave no reason to doubt that stich an accident may occur, and where competent observers have failed to detect any fracture. Such are the cases recorded by Sir William Fergusson,* Mr. Bryantf and Mr. Morris, J in which it would be difficult to believe that these skilled observers should have been mistaken in their diagnosis. The accident must be regarded as a recognised, but rare, lesion. At the same time it is probable that in most of the cases the injury will be found to be complicated with fracture of the bones of the leg or of the astragalus, as in a second case re- corded by Mr. Bryant, in the same place. The injury would appear almost always to b? produced in the same way, by falls from a great height on to the soles * Practical Svirgery, p. 277. 5th ed. t Practice of Surgery, vol. ii., p. 388. 4th ed.](https://iiif.wellcomecollection.org/image/b21518798_0512.jp2/full/800%2C/0/default.jpg)
