Volume 1

A system of surgery / Translated from the German, and accompanied with additional notes and observations, by John F. South.

  • Maximilian Joseph von Chelius
Date:
1847
Catalogue details

Licence: Public Domain Mark

Credit: A system of surgery / Translated from the German, and accompanied with additional notes and observations, by John F. South. Source: Wellcome Collection.

    994/1006 (page 810)
    fall of the body backwards, whilst the fore part of the foot is fixed, so that the shin-bone is brought into a nearly straight direction with the foot. In this position, the lower end of the shin-bone presses on the back of the astragalus, drives it forwards, and tears the astragalo-tibial ligament, and lets go the head of the astragalus from the hollow of the navicular bone. It is therefore intelligible, why dislocation does not occur when the shin-bone breaks, and this dislocation takes place, especially in powerful, healthy persons, whose bones arestrong. In dislocation inwards, indeed, there is always fracture of the lower end of the splint-bone. Most probably the head.-of the astragalus is always primarily dislocated forwards from the navicular bone, and driven according to the direction of the operating force, inwards or outwards. In twisting round of the astra- galus on its axis, it must be driven from behind, forwards, and from below, upwards, with a very great thrust of the shin-bone upon the foot and leg, whilst extended to the utmost, with which the skin yielding, indeed, though resisting, and the inter-osseous ligament must be torn through. (1) When Roenetra supposes that dislocation of the astragalus inwards, if not impos- sible, yet is in the highest degree difficult, because the cleft between the navicular bone and astragalus is filled by exceedingly strong ligaments, the capsule between the two bones in front too weak and extensible, and because the violence causing the disloca- tion must operate from before backwards; this can only follow on the primary dislo- cation of the head of the ustragalus, as the cases, known to the present time, show greater frequency of the dislocation inwards, than of that outwards. In his experiments, Rognetra has never been able to produce any other dislocation of the astragalus than that forwards. [The dislocation outwards is very rare; besides James’s, of Croydon, case (a), and two other under GuTuRir’s care (6), I know of none save one nowjunder my friend SraNnLEy’s care in St. Bartholomew’s Hospital, and which had occurred in consequence of the young man slipping off the fourth round of a ladder, the appearances of which corresponded very closely to the description given by AstLey CooPer, but there is not any fracture of the splint-bone. Violent attempts had been made for its reduction before his admission into the hospital some days after the accident, but, as in the other three cases, without success. Reduction was also attempted two or three days after his admis- sion into St. Bartholomew’s, but they also were quite unavailing, and the displacement still remains. Of these cases, JAMES’s was the only one in which there was fracture of any bone, and in that the inner malleolus was broken obliquely.—J. F. S.] 1098. In dislocation of the astragalus forwards, the projection of the head of that bone upon the navicular, is felt on the instep, the toes are depressed and turned somewhat outwards. In the dislocation zmwards, the projection is more to the inner side, and the toes turned more outwards (1) ; and in dislocation outwards, the prominence of the head of the astragalus | upon the cuboid bone, and the foot is so turned inwards, that the outer edge is directed downwards, and its inner, upwards. With much swelling the diagnosis is difficult, and even impossible (Boyrr.) If the soft parts be at the same time torn, the head of the astragalus either protrudes or may, with the finger, be felt bared. In dislocation of the astragalus, with twisting on its axis, it may be so locked in between the shin-bone and heel-bone, that the limb appears longer. If, however, this be not always the case, this sign is extremely important, in order to suspect such dislocation, and always to avoid, in such eases, useless and prejudicial attempts of extension and counter-extension (ROGNETTA.) (1) The younger Cirnr’s case of simple dislocation ; and GREEN’s case of compound dislocation inwards (c). (a) Cooper, above cited, p. 359. (b) Hancocn’s Paper; in Med. Times, vol. ii. 1844, p. 71. (ce) A. Cooper, p. 364.