Fig. 334
Fig. 335
Fracture of upper end of tibia.
Transverse fracture, with anterior displacement. (From the Buffalo Museum.)
Line of fracture at junction of lower and middle thirds of tibia.
While wire sutures may be used as freely as may be indicated it will be well, at least in the majority of cases, to leave the ends protruding in such a way that they can later be untwisted and removed. The presence of wire after a certain length of time rather interferes with the process of ossification than helps it.
Fractures of the lower end of the leg nearly always involve the joint, to some extent at least, in respect of being accompanied by sprain if nothing else. They are accompanied by displacement of the foot, and are produced by violence, which first involves the foot. The term “Pott’s fracture” is meant to include the injury originally described by Pott himself. In the typical Pott’s fracture, as shown in [Figs. 336] and [337], there are a chipping off of the internal malleolus, of the outer portion of the articular end of the tibia, and fracture of the fibula a little above the joint. In spite of the classical description which Pott gave fractures of the fibula alone, those accompanied by tearing of the internal lateral ligament, or chipping off of the malleolus, are frequently referred to under the same term. The more complete the injury the greater the possibility for displacement. Eversion and outward displacement, of course, are conspicuous. Lesser degrees of injury are accompanied by less displacement, but all of these injuries will be followed by extreme swelling of the ankle-joint, which may at first make diagnosis somewhat difficult, because of the extreme tenderness which prevents the handling necessary for careful determination. It is not always easy to so completely replace the bones, when we have the combination of three fractures as above, as to get an ideal result. Nevertheless with suitable treatment usually very useful limbs are secured. When the injury has been made compound the difficulties are increased. Such a result will not be obtained, however, unless the tendency to backward and lateral displacement be overcome, when the limb is placed in its permanent plaster-of-Paris splint, as it should be after a few days. Great care should be given to this point in the management.
Fig. 336