File:Excision of astragalus.jpg

and inwards-Excision of the Bone-Recovery with a Useful Limb. BY JOHN H. BRINTON, M.D., Surgeon to the St. Joseph's Hospital, Surgeon to the Philadelphia Hospital, and Lecturer on Operative Surgery in the Jefferson Medical College. On the morning of October 20, 1868, Mr. L., of South Caro- lina, æt. 75, fell through a trap-door into a cellar about nine feet deep, striking the rounds of a ladder in his fall. He was unable to rise, and was carried up the ladder on the back of a man. A neighboring physician was called in, a dislocation of the ankle pronounced, and reduction under ether attempted. This failing, the limb was temporarily dressed, and the patient was sent in a carriage to his residence in the country some ten miles distant. At ten P.M. of the same day I saw Mr. L., in consultation with Dr. Moss, and recognized a complete luxation of the astrag- alus forwards and inwards. The integument was untorn, but was tensely stretched over the head of this bone and over the inner malleolus, which latter appeared very prominent from the displacement of the astragalus. The foot below the scaphoid and cuboid bones was markedly everted. The fibula was frac- tured transversely about one inch above the external malleolus. The patient was again etherized, and powerful attempts made to reduce the luxation, but so tightly locked were the bones that no change whatever was effected in the position of the parts. Operative interference being at this time absolutely contra- indicated by Mr. L.'s condition, the limb was placed in a bran-