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C^.S’^^.S’ ILLUSTRATING THE TREATMENT. 151
XXIII. DOUBLE FEACTUEE OF FIBULA AT ITS LOWEE
THIED, WITH FEACTUEE OF THE INTEENAL
MALLEOLUS.
W. E., 24 years old, Lieutenant in the 97th Austrian
Infantry Eegiment, was carried to the Marine Hospital on the
1st of February 1889. He had been riding on horseback. The
horse fell, and he had his right foot under it. The foot was
strongly inverted just after the accident. The patient complained
of fearful pain, especially at the internal malleolus. The parts
round the ankle were greatly swollen. Examination showed
fracture of the fibula at its lower third, where crepitation was
felt. The internal malleolus was also believed to be broken, but
owing to the pain and excessive swelling it could not with
certainty be decided to what extent. The leg was put in a
Petit-boot. The pain grew so unendurable during the night that
the patient had to send for the resident surgeon, who ordered
an ice compress. On the 4th, several bullfe, each the size of a
sixpence or more, made their appearance on the inner and lower
part of leg and ankle. They contained serum ; were opened and
treated with iodoform bandasfe.
On the 12 th of February I saw the patient for the first time.
The foot and leg were immensely swollen, the swelling ex-
tending as high as the knee-joint. The exudation was rather firm,
pitted everywhere deeply on pressure, and the pits remained long.
The skin had a greenish-yellow colour. There were three
especially painful places, and after the treatment had been given
for some time the fractures could very well be made out. One
was transverse 10 cm. high; another oblique, running from
below upwards and backwards, and ending posteriorly about
3 cm. above the tip of the external malleolus. Both were on
the fibula. On the internal malleolus there could be felt a
longitudinal furrow, starting at the tip and going upwards for a
distance of 2 cm., and then bifurcating forwards and backwards.
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