Anatomy, descriptive and surgical / by Henry Gray ; with an introduction on general anatomy and development by T. Holmes ; the drawings by H.V. Carter ; with additional drawings in later editions ; ed. by T. Pickering Pick.

  • Henry Gray
Date:
1883
Catalogue details

Licence: Public Domain Mark

Credit: Anatomy, descriptive and surgical / by Henry Gray ; with an introduction on general anatomy and development by T. Holmes ; the drawings by H.V. Carter ; with additional drawings in later editions ; ed. by T. Pickering Pick. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

    982/1036 (page 978)
    felt close to the fibula just below the head, and when pressed upon in this situa tion causes a sensation to run down its branches to the foot. THE LEG AN]J ANKLE. 115. Bony Points.—The tubercle of the tibia (for the attachment of the ligamentum patellas), the sharp front edge called the shin, and the broad flat subcutaneous surface of the bone can be felt all the way down. The inner edge can be felt too, but not so plainl3^ The lower third is the narrowest part of the bone and the most frequent seat of fracture. The head of the fibula is a good landmark on the outer side of the leg, aboui one inch below the top of the tibia and nearly on a level with the tubercle Observe that it is placed well back, and that it forms no part of the knee-joint, and takes no share in supporting the weight. The shaft of the fibula arches backwards, the reverse of the shaft of the tibia. The fact of the bones not being on the same plane should be remembered in flap amputations. The shaft of the fibula is so buried amongst the muscles, that the only part to be distinctly felt is the lower fourth. Here there is a flat tri- angular subcutaneous surface, between the peroneus tertius in front, and the two peronei (longus and brevis) behind. Here is the most frequent seat of fracture. IIB. Malleoli.—-The shape and relative position of the malleoli should be carefully studied, as the great landmarks of the ankle. The inner malleolus does not descend so low as the outer, and advances more to the front: at the same time, owing to its greater antero-posterior depth, it is on the same plane as the outer behind. The lower border of the inner malleolus is somewhat rounded, and the slight notch in it for the attachment of the lateral ligament can be felt. The outer malleolus descends lower than the inner, thus effectually locking the joint on the outer side. Its shape is not unlike the head of a serpent. Viewed in profile, it lies just in the middle of the joint. In Syme's amputation of the foot at the ankle, the line of the incision should run from the apex of the outer malleolus, under the sole to the centre of the inner. In a well-formed leg, the inner edge of the patella, the inner ankle, and the inner side of the great toe, should be in the same vertical plane. Look to these landmarks in adjusting a fracture or dislocation, keeping at the same time an eye upon the conformation of the opposite limb. [In consequence of violence, usually a sprain, a sliver of the internal surface of the thick malleoli may be broken off, seriously implicating the joint, but yet not perceptible by mobility, crepitus, or otherwise, from the exterior. Mr. Callender has happily named such, sprain-fractures. Into the inter-malleolar space the astragalus is tightly wedged or mortised, and we have h.ere, as I pointed out some years ago, a valuable means of diagnosis in case of Pott's fracture of the fibula three or four inches above the external malleolus. In such a fracture this inter-malleolar space is widened. If now the leg be seized by one hand above the ankle, and the foot by the other, with the palm under the sole, the thumb and fingers will have the astragalus in their grasp. The astragalus can then be pushed sidewise against the outer malleolus and then shoved suddenly towards the firm inner malleolus, against which it will come Avith an easily-perceived impact if there be fracture. If none exist, the astragalus will have no lateral play. Motion at the medio-tarsal joints must not be mistaken for this tibio-tarsal movement.] There are several strong tendons to be seen and felt ab.out the ankle. 117. Tendo Achillis.—Behind is the tendo Achillis, It forms a high relief, with a shallow gutter on each side of it. The narrowest part of the tendon, where it should be divided in tenotomv, is about the level of the inner ankle;