The Leg. 377 



of the leg. Displacement. Of course the direction and 

 obliquity of the fracture affect the position of the frag- 

 ments. If the obliquity be downwards and forwards, the 

 lower fragments are drawn up behind the upper frag- 

 ments by the gastrocnemius, assisted slightly by the soleus 

 and plantaris, but, if the obliquity be downwards and back- 

 wards, then the lower fragments override the upper, be- 

 ing drawn up by the same muscles. Flexion of the leg on 

 the thigh will relax the gastrocnemius muscle and thus 

 permit freer extension of the bones in endeavoring to co- 

 aptate them. 



Amputation of the leg. Amputation, at the "place of 

 election," i.e., about one hand's breadth below the knee 

 joint, is best performed by Faraboeuf's method, which con- 

 sists of an external and an internal flap. The external 

 flap is equal to the diameter of the limb at the level of the 

 saw line, i.e., it is one-third the circumference of the limb 

 at this point. The incision starts in front opposite the 

 saw line and passes down parallel with and internal to the 

 anterior border of the tibia. The posterior incision ends 

 above, opposite the anterior incision, but about one and a 

 half inches below the beginning of that incision. These 

 two incisions are joined by a curved one on the outer side 

 of the leg, while, on the inner side, the incision is carried 

 from the upper end of the posterior incision to a point on 

 the anterior about one and a half inches below its com- 

 mencement. The anterior tibial artery is in the external 

 flap which must not be separated too high for fear of 

 wounding that vessel where it perforates the intermuscu- 

 lar septum. The soft parts are retracted and the bone 

 divided at the desired line. On looking at the stump in 

 this operation, the anterior tibial nerve is seen to lie on 

 the outer side of the anterior tibial artery. The 

 posterior tibial and the peroneal vessels are found lying 



