Tuberculosis Of The Ankle

This most often affects the body of the astragalus. Sometimes the disease is located in the lower end of the tibia. In the former case other of the tarsal bones are also frequently involved. In the latter an extraarticular operation on the tibia above the internal malleolus may cure the disease, but the motion in the joint often remains impaired.

Fig. 570.   Ligaments of the outer side of the ankle.

Fig. 570. - Ligaments of the outer side of the ankle.

Excision Of The Ankle

Formal resections of the ankle are rarely performed. The joint is difficult to expose without extensive division of the tendons and other tissues. It is considered best to enlarge any existing sinuses and curette the dis eased bone away.

If it is desired to excise the joint it can be done by Konig's incisions, one along the anterior edge of the internal malleolus and the other along the anterior edge of the external malleolus. Through these incisions all that is necessary can usually be done.' Sprain of the Ankle. - In what is usually called a sprain of the ankle the injury is not always confined to the ankle-joint and its ligaments. It has been shown that in many cases there is a tearing off of small fragments of bone, hence the name fracture-sprain (Callender). The ankle-joint has an anteroposterior motion, but the lateral motion of the foot takes place mainly in the subastragaloid joint with some additional movement allowed by the other tarsal joints. Inasmuch as sprains are usually the consequence of a lateral displacement, the resultant injury is frequently in the subastragaloid and sometimes in the adjacent tarsal joints. This condition can be suspected when the pain and swelling is located below and in front of the ankle rather than around the ankle itself. The sprain is more often the result of inversion than of eversion of the foot. In eversion the plantar ligaments are so strong that the foot moves as a whole and the force is transmitted directly to the ankle and leg bones, and most likely results in the production of a Pott's fracture of the fibula with or without a tearing off of the internal malleolus or rupture of the ligamentum deltoideum (internal lateral).

Treatment

The principle of treatment in sprains is to prevent the ruptured ligaments and strained tissues being again irritated and kept from healing by subsequent movements of the injured parts. A small degree of movement is usually painless and unharmful, but a more extensive, and often accidental, movement causes the pain and disability to persist. The failure to apply an efficient dressing which properly limits motion until the primary effect of the injury has passed is the reason of these disabilities becoming chronic. Sometimes fixed dressings like plaster of Paris or silicate of soda are applied for two weeks. Fixation by adhesive plaster has been found very efficient. Gibney demonstrated this. Inasmuch as the injury is usually produced by inversion, the plaster is applied especially to prevent inversion and likewise to give general support. Gibney's method consisted in applying alternate narrow strips of adhesive plaster, one set beginning on the inner side of the foot and going well up on the outer side of the leg, and the other running parallel with the sole of the foot from the heel to the dorsum.

Another method consists in taking a long strip of plaster 7.5 cm. (3 in.) wide, and beginning high up the leg on the inner side, carrying it down under the sole and drawing it firmly up and fastening on the outer side of the leg almost to the knee. This is reinforced by encircling strips around the ankle and instep.

Fig. 571.   Ankle joint distended with wax. showing that its capsule is weak anteriorly and posteriorly and strong laterally.

Fig. 571. - Ankle-joint distended with wax. showing that its capsule is weak anteriorly and posteriorly and strong laterally.