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Dislocation of the Ankle.The ankle-joint is formed by the two bones of the leg above and by the uppermost bone of the foot - called the astragalus - below. The astragalus fits into a groove or mortise which is formed by the bones of the leg. The weight of the body is transmitted from the thigh to the foot by means of the large bone of the leg called the tibia ; the lower end of this rests directly upon the broad, curved surface of the astragalus. In order to prevent a displacement sideways, the joint is provided with a bony shoulder on either side of the astragalus : the inner shoulder is a projection of the tibia, while the outer shoulder is the end of the fibula. The astragalus is therefore covered above and on either side by the bones of the leg. The result of this arrangement is, first, that the ankle is protected from dislocations to a great extent ; and second, that when a dislocation is effected, there occurs almost invariably a fracture of one or,both of the bones of the leg. There are, however, dislocations in which the foot slips directly forward or directly backward without breaking either of the bones of the leg. Signs.-Dislocation of the foot forward is an infrequent occurrence. It can be readily recognized by the deformity of the foot and ankle. The heel disappears, since the heel-bone is pushed forward under the ends of the bone of the leg ; an unusual protuberance is felt at the upper surface of the foot just in front of the leg. Dislocation of the foot backward can be recognized by extreme length of the heel, the leg seeming to be planted at about the middle of the foot; the toes are pointed downward, the heel upward. Dislocation of the foot outward is accompanied by a fracture of the lower end of the fibula, which is generally broken two or three inches above the joint. This accident is therefore classed among the fractures rather than the dislocations, and has been already described under the head of " Pott's fracture. " It is usually caused by a " turning over" of the ankle. The sole of the foot is turned outward or even upward, while the inner side rests upon the ground. In some cases there is a fracture not only of the outer bone of the leg-the fibula-but also of the projection from the tibia which protects the inner side of the joint. Dislocation of the foot inward is accompanied by a fracture of the lower end of the tibia, and sometimes with a fracture of the fibula as well. In this case the sole of the foot is turned inward, so that the outer edge rests upon the ground. There sometimes occurs also an injury which is not necessarily a dislocation, though the astragalus may be actually forced out of place. This consists in a separation of the tibia from the fibula. In the natural condition these bones are bound tightly together by means of ligaments ; but in consequence of violence, such as a fall upon the feet, the bones are sometimes sprung apart. If they be widely separated the astragalus is forced up between them, causing a stiffness of the ankle and a shortening of the limb ; there may also be a fracture of one or both bones. This accident usually results in permanent loss of movement in the ankle. Treatment. --Dislocations of the ankle which are not accompanied by laceration of the flesh are usually reduced without difficulty, and do not cause permanent impairment of the movements of the joint. The general plan is to make extension, that is, pull the foot forcibly away from the leg, while at the same time the ends of the displaced bones are forced backward into position. In the backward dislocation of the foot, the leg should be bent upon the thigh so as to relax the muscles which are attached to the heel; in fact this measure is to be recommended in most of the dislocations at the ankle. Those displacements which are accompanied by fracture of the bones must be treated according to the principles already laid down in discussing fractures. If there be extensive injury to the flesh, the condition is always a serious one ; for in many instances amputation of the foot becomes necessary In every case, it is true, in which there is a chance of saving the member, the surgeon should postpone an operation, but it frequently happens that after weeks have elapsed it becomes evident that the bones are so injured as to be incapable of supporting the weight of the body ; and it is better to relieve the patient from the annoyance of the diseased bone. All such injuries to the ankle as are complicated with wounds of the flesh should be submitted to the care of the surgeon at once; a neglect to do so may cost the patient a limb or even his life. But first, if you want to come back to this web site again, just add it to your bookmarks or favorites now! Then you'll find it easy! Also, please consider sharing our helpful website with your online friends.
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