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Updated: May 13, 2025
That amputation for senile gangrene performed between the ankle and the knee seldom succeeds, is explained by the fact that the vascular obstruction is usually in the upper part of the posterior tibial artery, and the operation is therefore performed through tissues with an inadequate blood supply.
Washington reports in full the case of a boy of eleven, who, in handing a fowling piece across a ditch, was accidentally shot. The contents of the gun were discharged through the leg above the ankle, carrying away five-sixths of the structure at the time of the explosion the muzzle of the gun was only two feet away from his leg. The anterior tibial artery was fortunately uninjured.
In the meanwhile, cases are to be handled as though tibial fracture certainly existed. Prognosis. Prediction of the outcome in tibial fracture is somewhat presumptuous, but in the majority of cases in mature subjects fatality results. Cadiot , however, views this condition with more optimism than have American practitioners.
The joint capsule encompasses the articulation and is attached to the brim of the acetabulum and the edge of the head of the femur. The section passes through the middle of the groove of the trochlea of the tibial tarsal bone. 1 and 2. Proximal ends of cavity of hock joint. 3. Thick part of joint capsule over which deep flexor tendon plays. 4.
The 'superficial brachial vein', the 'cephalic' vein of the human subject, and the 'plat' vein of the farrier, may be resorted to in all lamenesses of the fore limb, and especially in all shoulder-wrenches, strains of the loins, and of the thigh and the leg, and muscular and ligamentous extensions of any part of the hind limbs; the 'vena saphena major', and the 'anterior tibial' vein may be punctured in such cases.
Morton mentions a boy of sixteen, who was struck by one of the blades of a reaping machine, and had his left leg cut through about 1 1/4 inches above the ankle-joint. The foot was hanging by the portion of skin corresponding to the posterior quarter of the circumference of the leg, together with the posterior tibial vessels and nerves.
Now, as it was an equinus, it was necessary to cut the tendon of Achilles, and, if need were, the anterior tibial muscle could be seen to afterwards for getting rid of the varus; for the doctor did not dare to risk both operations at once; he was even trembling already for fear of injuring some important region that he did not know.
When the tibial vessels can be felt pulsating at the ankle it may be justifiable, if the patient urgently desires it, to amputate lower than the knee; but there is considerable risk of gangrene recurring in the stump and necessitating a second operation.
The shape and size of a bone when injured, determines in a measure, the course and probable outcome in most cases, but of first and greater importance is the function of the bone. A fracture of the fibula in the horse need not incapacitate the subject, but a tibial fracture is serious and generally proves cause for fatal termination.
The superior extremity of the tibia shows a central spine margined laterally by rather plain articular faces. It articulates with the thigh bone. The muscles of this region are divided into two sub-regions, anterior and posterior tibial.
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