48 SURGERY. 



occur at the weakest points. The signs are evident : crepitus, pain, 

 want of motion, &c. There is seldom any great shortening, and 

 the deformity is readily reduced. 



Treatment. — When both bones are fractured, when the tibia 

 alone is fractured, or, when the upper part of the fibula is fractured, 

 the best and most simple apparatus is the fracture-box and pillow. 

 The fracture-box has a foot-board, to which the foot is secured by a 

 bandage, thus preventing any lateral inclination. In lieu of this, 

 two splints of the length of the leg, applied on either side of the 

 pillow, will answer the purpose, care being taken to support the foot 

 by a bandage or handkerchief. 



Fig. 8. 



Fractures of the lower end of the fibula are to be treated by Du- 

 puytren's or Physick's apparatus ; which consists of a single splint, 

 placed on the inner side of the leg, and reaching beyond the foot. 

 It is provided with a wedge-shaped pad, which reaches only to the 

 ankle, the larger end of which, being applied to the internal malle- 

 olus ; a bandage is carried over the ankle in such a manner as to 

 produce inversion of the foot, making the sole of the foot approxi- 

 mate the splint, and thus fragments are adjusted and the deformity 

 removed. 



FRACTURES OF THE BONES OF THE FOOT. 



The OS calcis may be fractured by great violence connected with 

 the action of the sural muscles. The tuberosity will be drawn up 

 by the tendo Achillis, and the patient is unable to stand. 



The treatment consists in overcoming the action of the triceps 

 surce, flexing the leg upon the thigh, and extending the foot upon 

 the leg. The fragments are to be approximated by a figure of 8 

 bandage. 



The astragalus is rarely fractured ; it may occur at the posterior 

 part where the tendon of the flexor longus pollicis plays over it ; or 

 it may occur between the body and the head. In the first instance 

 the foot will be inverted, in the latter but little deformity will occur. 



It can be treated successfully by a simple fracture-box. Should 

 caries take place it may become necessary to extirpate it. 



The metatarsal bones and the phalanges are seldom fractured, 

 unless the injury be complicated or compound. 



