556 



APPLIED ANATOMY. 



tissues. It is considered best to enlarge any existing sinuses and curette the dis 

 eased bone away. 



If it is desired to excise the joint it can be done by Konig's incisions, one along the 

 anterior edge of the internal malleolus and the other along the anterior edge of the ex- 

 ternal malleolus. Through these incisions all that is necessary can usually be done. 

 Sprain of the Ankle. In what is usually called a sprain of the ankle the 

 injury is not always confined to the ankle-joint and its ligaments. It has been shown 

 that in many cases there is a tearing off of small fragments of bone, hence the name 

 fracture-sprain (Callender). The ankle-joint has an anteroposterior motion, but the 

 lateral motion of the foot takes place mainly in the subastragaloid joint with some 



additional movement allowed by the other 

 tarsal joints. Inasmuch as sprains are 

 usually the consequence of a lateral dis- 

 placement, the resultant injury is frequently 

 in the subastragaloid and sometimes in the 

 adjacent tarsal joints. This condition can 

 be suspected when the pain and swelling 

 is located below and in front of the ankle 

 rather than around the ankle itself. The 

 sprain is more often the result of inversion 

 than of eversion of the foot. In eversion 

 the plantar ligaments are so strong that the 

 foot moves as a whole and the force is trans- 

 mitted directly to the ankle and leg bones, 

 and most likely results in the production of 

 a Pott' s fracture of the fibula with or with- 

 out a tearing off of the internal malleolus 

 or rupture of the ligamentum deltoideum 

 (internal lateral). 



Treatment. The principle of treat- 

 ment in sprains is to prevent the ruptured 

 ligaments and strained tissues being again 

 irritated and kept from healing by subse- 

 quent movements of the injured parts. 

 A small degree of movement is usually 



painless and unharmful, but a more extensive, and often accidental, movement causes 

 the pain and disability to persist. The failure to apply an efficient dressing which 

 properly limits motion until the primary effect of the injury has passed is the reason 

 of these disabilities becoming chronic. Sometimes fixed dressings like plaster of 

 Paris or silicate of soda are applied for two weeks. Fixation by adhesive plaster has 

 been found very efficient. Gibney demonstrated this. Inasmuch as the injury is 

 usually produced by inversion, the plaster is applied especially to prevent inversion 

 and likewise to give general support. Gibney' s method consisted in applying alter- 

 nate narrow strips of adhesive plaster, one set beginning on the inner side of the foot 

 and going well up on the outer side of the leg, and the other running parallel with 

 the sole of the foot from the heel to the dorsum. 



Another method consists in taking a long strip of plaster 7.5 cm. (3 in.) wide, 

 and beginning high up the leg on the inner side, carrying it down under the sole 

 and drawing it firmly up and fastening on the outer side of the leg almost to the 

 knee. This is reinforced by encircling strips around the ankle and instep. 



FIG. 571. Ankle-joint distended with wax, show- 

 ing that its capsule is weak anteriorly and posteriorly 

 and strong laterally. 



DISLOCATIONS OF THE ANKLE. 



The foot may be dislocated from the leg in nine different manners. 



1. The foot as a whole may be carried outward. This is almost always asso- 

 ciated with fracture of the fibula, and sometimes of the internal malleolus, constituting 

 Pott's fracture (see page 557). 



2. The foot may be carried directly inward. This likewise is associated with 

 fracture of the internal malleolus. 



