REGION OF THE ANKLE. 



559 



tendency of the foot to be drawn backward. After reduction not infrequently there is 

 no further tendency to displacement, and the fracture box or any other simple means 

 of retention is sufficient. 



In other cases it is better to place the leg in the Pott's position, viz., lying on 

 its outer side with the knee flexed. For similar injuries, Dupuytren advised placing 

 the leg on a straight internal lateral splint on a pad which extended from near the 

 knee down to the seat of fracture. The leg was fastened near the knee to the upper 

 part of the splint, and the foot which projected beyond the pad was drawn by 

 bandages toward the lower part of the splint. 



AMPUTATIONS AT THE ANKLE. 



When amputation is performed at the ankle it is usually either by the method 

 of Syme or that of Pirogoff. 



Syme's Amputation. "A transverse incision should be carried across the 

 sole of the foot from the tip of the external malleolus or a little posterior to it (rather 



Extensor longus hallucis 



Tibialis anterior 



Anterior tibial artery 



Tibia 



Tibialis posterior 

 Flexor longus digitorum 



Plantar arteries and nerves 



Extensor longus digitorum 



Fibula 



Feroneus longus 

 Peroneus brevis 



Flexor longus hallucis 



Pocket left by enucleating 

 the os calcis 



FIG. 575. Syme's amputation of the ankle. 



nearer the posterior than the anterior edge of the bone) to the opposite point on the 

 inner side, which will be rather below the tip of the internal malleolus. ' ' The extrem- 

 ities of this incision are connected by another directly across the front of the ankle- 

 joint. The anterior capsule is then divided and the lateral ligaments divided from 

 within outward. The foot being bent down, the tendo calcaneus is cut close to the 

 bone and the calcaneum dissected out. The malleoli are then to be cleared and sawn 

 off with a thin slip of the articular surface of the tibia (Fig. 575). 



Remarks: The incision across the sole must not go too far back on the 

 inner side, as the internal calcanean branch of. the external plantar artery will 



