Full resolution (JPEG) - On this page / på denna sida - Cases Illustrating the Treatment - XXIII. Double Fracture of Fibula at its Lower Third, with Fracture of the Internal Malleolus
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GASES ILLUSTRATING TEE TREATMENT. 153
shown in fig. 58. Wlien doing so for the first time, he slipped
and twisted the foot again. This gave him pain at the seat of the
fractures, but it speedily passed away on application of vibrations.
March loth. During the night he had felt pain in all the
fractured places, but it was very slight. Treated as usual and
made to walk as before.
March 14:th. Free from pain yesterday and last night. The
swelling, which is very stubborn on the inner side of the ankle
and round the Achilles tendon, has greatly subsided. The move-
ments in the foot are normal, except dorsi-flexion, which is
somewhat pi-evented by the Achilles tendon and by the tendons
passing round the thickened internal malleolus. The muscular
power developed is good. Is allowed to dress and go about the
room ;
must, however, when sitting keep the leg in the horizontal
position.
March 19ih. Walked out yesterday morning for the first time.
Had to go up and down two flights of stairs. Going downstairs
was somewhat difficult, but upstairs not. Went out again in the
afternoon and walked about for an hour in the hospital garden.
The patient was not allowed to use his own boots, but used a pair
of large ones.
March 23rcl. Walked into town yesterday with his ordinary
boots on. Felt nothing beyond a little stiffness in the ankle.
He was on his feet for over three hours. Walks with a full step.
March 30th. Goes on leave next Monday, the 1st of April.
Treated to-day for the last time.
The malleoli are thickened from the exudations at the seats of
the fractures. They have the following measurements in com-
parison to the sound ones :
—Internal malleolus on broken side,
4^ cm. broad ;
on sound side, 3^ cm. External malleolus, 3^
cm. on broken side ; 3 cm. on sound side.
The case ought to have been under manual treatment from the
very first day. The exudation would then never have been
allowed to settle as it did, and the recovery would consequently
have been very much quicker.
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