ABNORMAL CONDITION OF THE ANKLE-JOINT. 



161 



Partial luxation forwards of the tibia at 

 the external ankle, with fracture of the fibula 

 near the malleolus. 



Fig. 57. 



Viewed on the external side. 



Fig. 58. 



Viewed on the internal side. 



a, b, semicircular excavation posteriorly, and 

 projection of the heel backwards ; c prominence 

 formed by the tibia projected on the dorsum of the 

 foot; d displacement of the external malleolus 

 backwards along with the foot. 



was anxious, before these pages went to press, 

 again to examine this case, I requested Mr. S. 

 to make inquiry about her; he learned that 

 the woman died dropsical a few days before, 

 and with much difficulty procured for me an 

 opportunity to examine the limb, which on 

 careful dissection presented the following ap- 

 pearances: the whole extremity was somewhat 

 wasted, the skin on the sole of the foot was 

 smooth and fine, shewing that she had been 

 able to walk but little since the accident; the 

 foot was in a position of almost rigid extension, 

 the toes were directed downwards, the range of 

 motion of flexion and extension did not exceed 

 one inch, in short, all the usual characters 

 assigned to the partial dislocation forwards of 

 the tibia and displacement of the foot back- 

 wards were seen; when the skin was re- 

 moved from the fascia of the leg and foot, 

 the intervening cellular membrane was found 

 infiltrated with serum, the skin was adherent 

 to the inner malleolus, the vena saphena 

 and the nerve of the same name were thick- 

 ened and firmly connected together, the ex- 

 VOL. i. 



tensor tendons were stretched over the tibia, 

 and were somewhat flattened, and the grooves 

 which transmit the tendons that play behind 

 the inner and outer malleolus were deepened. 

 We now directed our attention to the state of 

 the bones; we found that the tibia was dis- 

 placed forwards, that its anterior edge was ad- 

 vanced more than one inch beyond its natural 

 situation, and that it much overhung the os 

 naviculare, but such was the direction and state 

 of obliquity of the tibia with respect to the 

 foot, that it could not be said to rest upon that 

 bone ; between the os naviculare and the infe- 

 rior articular extremity of the tibia there inter- 

 vened much fat of a yellow hue and fibrous 

 texture, like intervertebral substance ; the inter- 

 nal malleolus itself had not escaped injury, the 

 deltoid ligament had not in this instance as in the 

 former given way f the internal malleolus itself 

 had been broken, and a small portion of the back 

 part of the edge of the articular cavity of the tibia 

 was detached, and both malleoli were retracted, 

 or carried backwards with the foot; the fibula 

 above the fractured portion was directed down- 

 wards and a little forwards, and was somewhat 

 parallel to the tibia, yet. more than naturally 

 approximated to it, a circumstance which ac- 

 counted for the contracted rounded form the 

 middle of the leg possessed ; the lower frag- 



Fig. 59. 



Viewed on the external side. 

 Fig. 60. 



Viewed on the internal side. 



Skeleton preparations of fig. 57 and 58. 

 M 



