Potts Fracture 



497 



There may be no displacement with this fracture, but generally 

 the foot is everted, the astragalus being rolled outwards on its 

 antero-posterior axis, or even dislocated. Often the foot is rigidly 

 fixed in this everted position. Before trying to ' reduce ' it the knee 

 should be bent, so as to take all strain from the gastrocnemius. If it 

 still prove immovable, an anaesthetic may be required before the 

 soleus and the tibial 

 muscles permit of its 

 replacement. If, after 

 this, the parts cannot 

 be satisfactorily ad- 

 justed, it is advisable 

 to divide the tendo 

 Achillis, so as to in- 

 sure absolute quiet of 

 the calf-muscles. If 

 this be not done, the 

 leg should not be 

 fixed on a back splint, 

 as this keeps the knee 

 straight and the gas- 

 trocnemius in a state 

 of tension. Gypsum 

 or wooden side- 

 splints afford most 

 convenient support, 

 as then the knee can 

 be kept flexed and 

 the limb laid on the 

 outer side. 



In putting up the fracture it is very necessary to keep the foot 

 flexed at a right angle, or else, when the man begins to get about 

 again, the toes will be stiffly pointing downwards, and he will not be 

 able to get his heel to the ground. He fancies that the leg is shortened 

 by an inch or two, but with frictions and manipulations the ankle 

 soon becomes flexed again. Sometimes, however, the surgeon is 

 compelled to divide the tendo Achillis before the elevated heel 

 can be brought down. Not infrequently his neglect to fix the foot, 

 at the outset of treatment, with the toes pointing to the ceiling, is the 

 cause of his lame patient ultimately resorting to a 'bone-setter,' who 

 by rough and sudden flexion of the foot breaks down adhesions, and 

 snatches a triumph from orthodox surgery. 



It is quite possible to arrange the leg and foot in too straight a 

 line in adjusting a fracture near the ankle. It must be remembered 

 that the tibia is considerably bowed, and that the sole of the foot 

 naturally inclines a little inwards. 



K K 



Pott's fracture, showing rupture of internal lateral ligament. 



