Fig. 331
Fig. 332
Wiring tibia. (Lejars.)
FRACTURES OF THE FIBULA.
The lower end of this bone is much more often fractured than the upper, although it may be broken at any point. Into its upper termination is inserted the external lateral ligament, and this insertion may be torn off from the bone in cases of violent sprain of the knee, damage occurring which is similar to that which happens in injuries about the ankle. The upper portion of the bone lies well buried beneath muscles, and fractures here are not so easily recognized. A good maneuver for their recognition is to seize the bones at the lower portion of the leg and press them together; if such pressure gives severe pain above, or if it be shown that the fibula is more movable than natural, fracture may be practically diagnosticated, even though crepitus be not detected. A skiagram would, of course, clear up such a diagnosis.
Fractures of both bones of the leg occur almost as frequently as of either alone, usually as the result of direct violence, with or without more or less torsion; as, for instance, when the foot is more or less entangled, and, at the same time, twisted at the time of injury. These double fractures are by no means necessarily placed upon the same level; thus the tibia may be broken low down and the fibula high up, so high indeed that the latter fracture may escape observation. With fracture of both bones disability becomes complete, while shortening is very likely to occur, all the muscles passing from the leg to the foot conspiring to this effect. These fractures, moreover, are often comminuted and compound, sometimes to an extent necessitating exsection of fragments or of an inch or more from the shaft of each bone. In exsection of the tibia an equivalent amount should for obvious reasons be taken from the fibula. Displacements are extremely likely to occur, and in every compound fracture the presence of the opening may be utilized for the emplacement of sutures or suitable means for enforcing approximation. Indeed, other means failing, resort may be had to this measure in order to secure an ultimately good result.
Fig. 333
