166 REPORT—1840. 
very rare accident, exactly similar to that described by Mr. Adams in the 
Cyclopedia of Anatomy, article ANKLE. 
A woman aged sixty died inthe Glasgow Royal Infirmary in 1834, having 
an unreduced dislocation of left ankle forwards, of two years standing. 
The toes were pointed down, the ankle being stiff, in a state of complete 
extension. A deep curve is seen behind, where the tendo achillis 
should be straight ; the heel is lengthened, and the fore part of the foot 
is shortened. The anterior edge of lower end of tibia makes a projec- 
tion in front, and a notch exists below it, between it and dorsum of 
foot. Outer ankle is in its proper place, but inner one is thrown for- 
ward about $ths of aninch. On dissection, tibia is found above $ths of 
an inch further forward than natural ; its anterior edge being exactly over 
articulation of astragalus with os naviculare, and nearly {ths of an inch 
above it, so that a small part of scaphoid cavity of tibia behind still 
rests on the pulley of the astragalus. The tendon of the tibialis anticus 
by this means runs in a straight line to its insertion at the internal cu- 
neiform bone, instead of curving forward. Behind, the astragalus pro- 
jects so much, that the flexor longus pollicis does not run in its groove 
on the tibia at all. Astragalus and os calcis are in their proper rela- 
tion to each other. External malleolus remains in its place, with the 
ligaments entire. A hollow mark runs upward and backward from its 
anterior edge, showing where fracture had occurred ; the superior por- 
tion being thrown forward along with the tibia. Some new bone is de- 
posited on their junction. The peroneal tendons preserve their proper 
relations. Internally, the deltoid ligament has been ruptured. 
Neither Sir A. Cooper nor Dupuytren has ever seen a dislocation 
backward. Those cases which have been supposed to be such, have 
probably been fractures close to the joint, like the following. 
A man aged forty-one was admitted into the Glasgow Infirmary in 
1834, having injured his left ankle three years previously by a fall, 
being struck on front of leg, immediately above joint, bya plank. Some 
portion of tibia was felt attached to astragalus, while shape of tibia was 
thrown backward. Considerable doubt existed whether fibula was 
fractured or dislocated. Leg was 3ths of an inch shorter than right, and 
foot was very long in front, and very short behind. When he walked, 
lower end of shape of tibia pressed against tendo achillis, making it 
project backward, and causing acute pain. The foot was amputated. 
On dissection, tibia and fibula are found fractured transversely, imme- 
diately above ankle-joint. Each malleolus remains in its proper situa- 
tion. A thin arch of the tibia, not a quarter of an inch in thickness, 
remains over astragalus, and has formed a ligamentous connexion with 
its articular surface. Fractured surface has become smooth, and co- 
vered with a periosteum. The shafts of the bones pass backward and 
downward ; their extremities are covered with cartilage, and have re- 
ceived new fibrous capsules, derived from the deep fascia of the leg, in 
front and on each side of the tendo achillis. End of tibia does not 
rest on os calcis, but presses downward and backward against the ten- 
don. 
Mr. Douglas has since seen another case precisely similar to the above. 
