leg._

A fracture of the ankle joint is really a fracture of the lower
extremities of the bones of the leg. There are present pain and great
swelling, particularly on the inner side of the ankle at first, and
the whole foot is pushed and bent outward. The bony prominence on the
inner side of the ankle is unduly marked. The foot besides being bent
outward is also displaced backward on the leg. This fracture might be
taken for a dislocation or sprain of the ankle. Dislocation of the
ankle without fracture is very rare, and when the foot is returned to
its proper position it will stay there, while in fracture the foot
drops back to its former displaced state. In sprained ankle there are
pain and swelling, but not the deformity caused by the displacement of
the foot.

This fracture may be treated temporarily by returning the foot to its
usual position and putting on side splints and a back splint, as
described for the treatment of fracture of the leg.

=COMPOUND OR OPEN FRACTURE OF THE LEG.=--This condition may be
produced either by the violence which caused the fracture also leading
to destruction of the skin and soft parts beneath, or by the end of a
bony fragment piercing the muscles and skin from within. In either
event the result is much more serious than that of an ordinary simple
fracture, for germs can gain entrance through the wound in the skin
and cause inflammation with partial destruction or death of the part.

=Treatment.=--Immediate treatment is here of the utmost value. It is
applicable to open or compound fracture in any part of the body. The
area for a considerable distance about the wound, if covered with
hair, should be shaved. It should then be washed with warm water and
soap by means of a clean piece of cotton cloth or absorbent cotton.
Then some absorbent cotton or cotton cloth should be boiled in water
in a clean vessel for a few minutes, and, after the operator has
thoroughly washed his hands, the boiled water (when sufficiently cool)
should be applied to the wounded area and surrounding parts with the
boiled cotton, removing in the most painstaking way all visible and
invisible dirt. By allowing some of the water to flow over the wound
from the height of a few feet this result is favored. Finally some of
the boiled cotton, which has not been previously touched, is spread
over the wound wet, and covered with clean, dry cotton and bandaged.

Splints are then applied as for simple fracture in t