When simple, these injuries are often overlooked, on account of the difficulty of eliciting the signs of fracture from the swelling which accompanies them. They are best treated in a moulded splint.
Compound fractures are more common, and are to be treated on the same principles as govern such injuries elsewhere.
A fracture of the base of the fifth metatarsal has been described by Sir Robert Jones. It is produced by the patient coming down forcibly on the lateral edge of the foot while the foot is inverted and the heel raised—as, for example, in dancing. There is a localised swelling over the base of the fifth metatarsal, and pain when the patient puts weight on the foot. There is no crepitus or deformity. The fracture is readily recognised by the Röntgen rays. Massage and movement are employed from the first.
Dislocations in the Region of the Ankle
Dislocation of the Ankle-Joint.—In describing dislocation of the talus from the tibio-fibular socket, the varieties are named according to the direction in which the foot passes—backward, forward, medially, laterally, or upward.
All of them may be complete, but they are more frequently incomplete, and are liable to be rendered compound, either from tearing of the skin at the time of the injury, or by its sloughing later. Although as a rule there is little difficulty in effecting reduction by manipulation, these injuries are liable to be followed by stiffness and impaired usefulness of the joint.
The backward dislocation is the most common, and results from extreme plantar flexion of the foot, as from a fall backwards while the foot is fixed, wedging the talus between the tibia and fibula. The collateral ligaments are torn, and one or both malleoli may be broken, or the posterior part of the articular edge of the tibia chipped off ([Fig. 99]).
Fig. 99.—Radiogram of Backward Dislocation of Ankle.
(Professor Chiene's case.)