We do not share in the dissatisfaction expressed by some surgeons, notably Arbuthnot Lane, as to the results obtained by non-operative means in the common fractures of the leg, and do not recommend a systematic resort to operative treatment.

Un-united fracture of the bones of the leg is sometimes met with. It is treated on the same lines as in other situations, but may prove extremely intractable, especially in children, in whom, indeed, it is sometimes incurable.

Mal-union, on account of the disability it entails, may call for operative treatment in the form of osteotomy of one or both bones.

Compound fractures of the leg are common, and are treated on the lines already laid down for the treatment of compound fractures in general ([p. 25]).

Fracture of the tibia alone, when due to direct violence, is usually transverse, there is little displacement, and as the fibula retains the fragments in position, union usually takes place rapidly and without deformity. Oblique and spiral fractures result from indirect violence.

Fracture of the fibula alone may result from direct violence, and, on account of the support given by the tibia, is usually unattended by displacement. Bennett of Dublin has pointed out that it is common to meet with an oblique fracture of the upper third of the fibula as the result of an outward twist of the ankle while the foot is extended. It is characterised by pain localised at the seat of the break, on moving the foot in such a way as to bring the talus to bear against the fibula. Local pressure also may make the fibula yield and may elicit crepitus. In some cases this fracture is associated with sprain of the ankle-joint. It is often overlooked, and from want of proper treatment may result in prolonged impairment of usefulness.

Fractures of the tibia or fibula alone are treated on the same lines as fractures of both bones, and splints are rarely necessary. The ambulant method is useful in these cases ([Fig. 95]).

CHAPTER VIII
INJURIES IN REGION OF ANKLE AND FOOT

The fractures in this region include Pott's fracture, and its converse; separation of the lower epiphysis of the tibia; fractures of the talus, calcaneus, and other tarsal bones; and fractures of the metatarsals and phalanges. Various dislocations also occur, the most important being those of the ankle joint, of the talus, and the sub-taloid dislocation.