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CASES ILLUSTBATING THE TREATMENT. 155
XXIV. DOUBLE FEACTUEE OE THE FIBULA AT ITS
LOWEE THIED.
On the 15th of January 1887, Mrs. L., 43 years old, slipped
and fell as she was stepping out of her carriage. She rose up
and fell again. On both occasions she heard a distinct cracking
in her left ankle. The second time of falling she fainted
away.
On examination it was found that the fibula had sustained two
fractures : one oblique, running from below forwards and outwards,
about 10 cm. from the tip of the external malleolus; the other
transverse, about 3 cm. from the tip of the same malleolus. At
the upper seat of injury the pieces of bone were somewhat dis-
placed, and here the effusion appeared first ; at the lower there
was no displacement, but the fracture was felt very well when
the foot was inverted.
^ogress. —Jan. 15th. Between the first two applications of
the treatment on the day of the accident, the swelling did not
increase very much, and the patient had no pain.
Jan. 16th. During the preceding night, a considerable amount
of effusion had collected round the ankle, over the dorsum of the
foot, and upwards as high as the upper third of the calf. It was
not very tense, and pitted easily on pressure, but the depressions
quickly disappeared. There was no discoloration. The patient
had slept well and had had a painless night.
Jan. 23rd. The effusion has passed almost entirely away, remain-
ing only over the fractures and on the inner side of the ankle
;
but the cause of its appearance in the latter place was, I believe,
gout, which was present as a complication. Over the whole of
the leg in general no discoloration had been present, except a
slight yellowish tinge ; but high up on the posterior surface of
the calf I noticed on the morning of the l7th a dark blue
colour, which indicated to me that I had not carried the treat-
ment sufficiently far.
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