s along the crest of
the shin, and at this point abnormal mobility, tenderness, and
crepitus can usually be elicited. It is often difficult to detect the
fibular fracture, and it is not always advisable to attempt to do so,
especially if the manipulations cause pain or tend to increase the
displacement. The condition of the fibula is usually to be inferred by
noting the amount of displacement and the extent of mobility of the
tibial fragments. Not infrequently the seat of fracture may be
recognised by locating a point at which pain is elicited on making
pressure over the bone at a distance--pain on distal pressure.

On account of the close connection of the skin to the periosteum on
the subcutaneous aspect of the tibia, the tension caused by
extravasated blood is often extreme; blisters frequently form over the
area of ecchymosis, and when these become infected, sloughing of the
skin may take place and the fracture thus be rendered compound.

The vessels and nerves of the leg are seldom seriously damaged.

_Treatment._--If there is marked displacement, reduction is most
satisfactorily accomplished under anaesthesia. Traction is made upon
the foot and the fragments are manipulated into position, the pointing
of the toes and the outward rotation of the foot being at the same
time corrected. The normal outline of the foot in relation to the leg
is restored when the ball of the great toe, the medial malleolus, and
the medial edge of the patella are in the same vertical plane. As in
other fractures of the lower extremity, the limb should be placed in
the natural position of slight eversion: not with the toes pointing
straight forward.

The retentive apparatus to be applied depends upon the tendency to
re-displacement, the degree of swelling, and the extent of the damage
to the skin.

In the average case, the leg is supported between sand-bags, and
massage and movements are employed from the outset. When there is a
tendency to re-displacement, the limb may be immediately enclosed in a
rigid apparatus, such as lateral poroplastic splints retained in
position by an elastic bandage, or a Cline's splint, which can readily
be removed to admit of massage. When the fracture is in the lower
third of the leg, the ambulatory splint gives excellent results, and
is of special service in hospital practice (Fig. 95).

As an emergency appliance, for example for purposes of transport, the
_box splint_ (Fig. 91) is simple and efficient