732 



APPARATUS OF LOCOMOTION. 



Second stage. Disarticulation : The tendon of the extensor pedis 

 is divided and the joint opened. The claw is pressed backwards, and 

 first the external and internal ligaments, then the flexor tendons of 

 the phalanges, are divided. 



This operation is of no great use, because, on account of the 

 position of the joint and the arrangement of the articular surfaces, 

 the end of the second phalanx extends beyond the line of section. To 

 avoid complications, therefore, it is better to remove the lower extremity 



Fig. 298. — Amputation of the 

 two last plialanges. First 

 and second phases. 



Fig. 299. — Amputation of the two 

 last phalanges. Third phase. 



of the second phalanx, which, moreover, is always injured to a greater 

 or less extent in cases of pedal arthritis. To effect this it is only 

 necessary to draw back the flap of skin a little and rapidly divide the 

 second phalange at its upper third with a fine saw. The points of 

 section of the tendons and ligaments must be carefully examined, and 

 if they exhibit necrosis should be further shortened. 



The stump is enveloped in a surgical dressing fixed to the pastern. 



Amputation of the two First Phalanges. — ^When necrosis is 

 very serious and has extended a long way upwards, it is often better 

 immediately to resort to amputation of the two last phalanges. 



