55 2 



APPLIED ANATOMY. 



in some cases to allow of the displacement being remedied. If this fails extension 

 may be tried or tenotomy of the tendo calcaneus should be done and the fragments 

 will at once come into good position. 



Woolsey has pointed out that the weight of the foot tends to its outward dis- 

 placement but another reason is that the insertion of the tendo calcaneus is not 

 beneath the middle of the ankle-joint but more towards its outer side, so that when 

 it contracts it carries the foot outward. The flexor and extensor muscles of the leg 

 balance each other, but the peronei muscles on the outer side have no additional 

 corresponding opponents on the inner side; hence another reason for displacement 

 of the foot and lower fragment outward. 



AMPUTATION OF THE LEG. 



Amputation of the leg is best performed at the place of election, a hand's 

 breadth below the knee-joint. This site is preferred because it gives a sufficient 



Extensor longus digitorum 



Anterior tibial nerve 



Anterior tibial artery 



Peroneus longus and 

 peroneus brevis 



Musculocutaneous nerve 



Peroneal artery 



Soleu 



Gastrocnemius 



Tibialis anterior 



Interosseous membrane 



Tibialis posterior 

 Flexor longus digitorum 

 Flexor longus hallucis 



Posterior tibial artery 

 Posterior tibial nerve 



- ~^__ 

 FIG. 565. Amputation of the upper third of the leg. 



length to the stump below the knee and allows sufficient space below for the instrument 

 maker to place the mechanism of the artificial leg which operates the foot. The 

 sharp projecting edge of the crest of the tibia tends to produce ulceration of the tissues 

 or skin in front of it, therefore it is to be cut off obliquely. 



The fibula, if divided at the same level as the tibia and especially if antero- 

 posterior flaps are used, tends to project too prominently on the outer side, hence it 

 is preferable to divide it at a higher level than the tibia. 



The anterior tibial artery is to be sought for on the interosseous membrane close 

 to the tibia with its nerve to the outer side. 



The posterior tibial and peroneal are at the same level on the tibialis posterior 

 muscle with the posterior tibial nerve lying superficial to the posterior tibial artery 

 (Fig. 565). 



