4. Rupture of the tendon Achillis.
5. Sprains of the ankle.
Fractures of the Lower Ends of the Tibia and Fibula. Commonly given the name of Pott’s Fracture. They may be the result either of forcible abduction or eversion of the foot, or of inversion or adduction. If the sole or main movement is eversion, the internal malleolus is broken, and if the force continues to act, it also causes the external malleolus to be broken. In the second variety, fracture by inversion, the first effect of the force is to break the fibula at the external malleolus. If the movement continues, the internal malleolus or a greater portion of the tibia is broken off.
Diagnosis. The diagnosis is usually easy to make. The ankle joint is greatly swollen, the depression, normally present in front of and behind the malleoli, being obliterated. The foot is displaced outward, and the internal malleolus is prominent. This deformity will often persist and become a cause of disability after healing of the fracture.
There is also backward displacement of the foot. These displacements may be so marked as, at first glance, to resemble a true dislocation of the ankle.
Abnormal lateral and anteroposterior mobility may be ascertained by grasping the sole of the foot with one hand and moving it inward and outward, or backward and forward, while the other hand steadies the leg. There is great tenderness between the tibia and fibula at the front of the ankle, and over the points of fracture in the malleoli.
If the fibula alone be broken, abnormal mobility and crepitus may be elicited by pressing its tip inward with the index finger of the one hand while a finger of the other hand is placed at the seat of fracture.
In some cases of Pott’s fracture the foot will move inward instead of outward. The degree of outward displacement can be measured by the difference in the distance from the front of the ankle to the cleft between the first and second toes, as measured on the sound and injured foot. There is not always complete loss of function. In fractures of the external malleolus alone, the patient may walk quite well.
Treatment of Fractures of the Leg. The treatment of a simple fracture of one or of both bones of the leg depends first, upon whether or not swelling is present, and second, upon the amount of displacement of fragments and our ability to keep them in apposition after reduction. If the case is seen within a few hours after the injury and but little, if any, swelling be present, the following is a perfectly safe and justifiable method of treatment:
The limb is wrapped with strips of sheet-wadding from the toes to the middle of the thigh, and a circular plaster of Paris cast is applied extending over the same area. Before the cast is dry, it is cut open along the median line, in front, to allow for any swelling. The cast is best applied while the patient is under the influence of an anesthetic, so as to permit reduction of the fragments by traction upon the foot. In from ten days to two weeks the cast should be removed and a fresh one applied. The second cast does not require to be cut open, and can be left on the limb until the end of the fourth week. It is then removed and if union be complete, no further cast need be worn. Massage of the limb and passive and active motion are now begun.