A. Bacot
1921 BMJ (Clinical Research Edition)  
IDENTITY OF RICKETTSfA 3ODIES IN LIT. "G"aror 156 TAIC 290 19211 NZIM~~~~~~~~~~~~~~~~~~~~~~DAL JOU3!NAL of the peroneu § tertius" almost completely frayed through, was found crossing the wound. This tendon was retracted inwards, and it was, then found that the astragalus "was completely free from all -its-attachments, the posterior surface pointing directly outwards and the head inwards. By forcing the foot into an exaggerated varus position' and turning the bone it was possible to replace it
more » ... ble to replace it so that it occupied its normal position. The foot was then everted, and the torn dorsal ligaments repaired and the peroneus tortius tendon sutured. Thle fibula fracture was positioned and the wound closed by interrupted sutures, and splinted on a metal shoe with a rectangular foot-piece. Gentle effleurage was commenced a fortnight later with active flexion and extension of the ankle under supervision to ensure that no inversion of the foot should occur. In the intervals of treatment the foot was retained in the splint. At the end of this time (six weeks after operation) there was very useful movement. Weight bearing was not permitted until three months had elapsed from' the date of the injury. Since that time the man has walked comfortably on the foot. Fig. 3 shows the lateral view after reduction of the dislocation. Figs. 4 and 5 show tlle range of ankle movement. This case has been very instructive, particularly bqcause it sliows that removal of the completely detached astragalus is not essential, and tllat excellent function with no shortening-a result much superior to that obtained after astragalectomy-may be obtained by this more conservative method.
doi:10.1136/bmj.1.3135.156 fatcat:yudohzgh6zfc7pv5eo6hidpevq