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TRANSVERSE ROTATION OF THE SEGMENTS OF THE LOWER EXTREMITY IN LOCOMOTION

A. S. Levens, Verne T. Inman and J. A. Blosser J Bone Joint Surg Am. 1948;30:859-872.

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TRANSVERSE

ROTATION EXTREMITY

OF

THE IN

SEGMENTS LOCOMOTION
T. INMAN, M.D.,

OF
*

THE

LOWER

BY

A.

S.

LEVENS,

M.S.,

C.E.,

BERKELEY, BLOSSER, M.D.,

VERNE BERKELEY,

SAN

FRANCISCO,

AND

J. A. Iro,,o the nier,sity of California,

CALIFORNIA

College

of Engineering,

and

Division

of Orlhopaedic

Surgery,

,lfedical

Scho3l

A complete

analysis

of human

locomotion

is difficult.

The

fact

that

persons

walk

and

run with employed

not 1cm only relation

apparent ease, and without conscious effort, does are simple or readily understood. A comprehensive analysis of the movements of the various segments
of these movements with force studies and muscle

not. imply that. the mechanisms study of locomotion includes of the body, but also the conaction. Consideration of a prob-

of such to

complexity present. but

suggests one

that component.

delimitations in the

are

necessary,

and pattern

the

present

study lower cxof have

endeavors
tremity.

displacement with the

It

of the

Many the various described

observers

investigators

segments
the motions

have reported their of the body, as projected

projected onto the frontal

findings upon
plane.

regard to parasagittal
is doubtful

the movements plane. Few

that any

previous

ments little the

have attempted to measure the of the low-er extremity, as projected attention has been given to transverse plane
indications

transverse rotatory upon a horizontal rotatory motions, regarded rotations as a more of the

motions of the various segplane. It is conceivable that possibly because motion in significant various act-ion in human of the
lowcr

parasagittal
Present

has
are

usually that

been transverse

propulsion.

segments

extremity In order
at

are an important factor in the ease to improve function, reduce fatigue, points on the stump of the amputee,

and rhythm and prevent provision

of walking of normal individuals. more or less continual abrasion in the prosthesis for
be

critical

allow-ing
a major

transverse rotations of the same order of magnitude contribution toward the improvement of artificial Transverse rotations, as discussed herein,
various study of

as those in normal legs may legs. refer to angular d!isplaccments axes. Results
twelve

of
provided

the of a

bone
these

segments
movements

of the
in

leg about
twenty-six

their

longitudinal
individuals,

are
of

presented
thom

normal

completely

satisfactory

data. study were: of transverse rotations with regard rotations with respect to artificial of the limbs. segments other. of the lowcn

The primary objectives in this 1. To determine the magnitude extremity, 2. To and their relative ideas for transverse design formulate

to each

TECHNIQUES

Placenient

of Pins threaded bony pins, 2.5 millimeters prominences adjacent in diameter, to the hip were drilled firmly into the and knee joints, sterile pre-

Stainless-steel contices of the

various

cautions and local anaesthesia being used. Targets, each consisting of a light w-ooden rod wit.h spheres attached! at tw-o points, were fastened to the pins. Figure 1 shows pins No. 1, No. &, and No. 3, placed in the iliac crest of the pelvis, in the adductor tuberele of the femur, an(! in the upper portion of the tibia (tibial tubercle), respectively. The insertion
*

In

Soptember

1945,

a research

project

on

prosthetic

devices

was

undertakon

at.

the

Univorsity

of

(alifornia, ated by program

OI,.
30-A,

supervised
the National is directed
NO. 4,

by Professor H. D. Eberhart of the Civil Engineering Division. The work was initiResearch Council, at. the reQuest of the Surgeon General of tho Army. The national by the Committee on Artificial Limbs of the National Research Council.
194$

OCTOBFR

85

S6()

A.

5.

LEVENS,

V.

T.

INMAN,

AND

J.

A.

BLOSSER

of pin
fmom knee
tile

No.
-as

2 into the iat.eial aspect

suppressed.

medial sidle so restricted

of

tile

femur

as

movement

dict-atco! by the fact of the iliotihial tract. that

that
motion

placement.
at the

( OlleCtiofl
A (11 ronizc(l second, the oli(ular

of Data photographic
35-millimeter with a shutter The cameras ncfcrcn(c tccoro! o1 the motion-picture

movement.
cameras,

of
orientc(l

tile

targets operating at- distances the

mannel

was at to

obtained forty three front

,

by -eight

three frames feet

synper from

speed
were

of 1, 96 second!,
so located planes as
.

of twenty-five

siibjO(t.

to

refer

targets

mutually
and side

penpenviews

(o-o)r(!inate

( Fig.

2 ) Iti this

top,

of

Fmu.

2 data. (ReMonthly,

Flo;. the related sul)jcct frames crc

,

1 simultaneously. we ii studied

Fig. 1: Subject with limls and targets attached. Fig. 2: Arramigemiient for recording pin-study produoed, liv J)crn)issiomi, fromu Populer Scien.ce page 82, July 1947.)

obtaine(l \Vhi(ll

from

A clock enlarged!

mechanism proj ectcd

made images.

it possible

to identify

Reduction
The co-ordinates
perspective

of I)ata
first method

employed
targets. This

in
-as

the felt

reduction necessary

of data to

made for

use

of computed errors

space due to

of the

correct

possible

between
obtained
UOI1

amid parallax. Later it was found that. in certain cases the values of the angles pins, ol)tamed from orthogonal projections, compared quite favorably with values from measurements taken directly from the photographs, showing the projections
the

Further horizontal, zontal middle

horizontal study the angle

plane showed between yielded! of the

only. that. the results stance

if the pins, that phase;

pins read

isene

set

horizontally from the 2 degrees variation of toe-off. methods.

or within photographs

10 degrees showing hori-

of

directly

projections, 60 per cent.

were within the maximum at the instant from the tw-o

of the true values for the between values obtained Phase relationships The differences the were between

by the two not affected

methods was 5 to 6 degrees by the results obtained

computed values and those obtained directly from not significant, since the variations were less t.han the
tested.
TilE

the motion-picture variations among

frames were individuals

JOURNAL

(IF

BONE

AND

JOINT

SUR(;ERY

THE

SEGMENTS

OF

THE

LOWER

EXTREMITY

IN

LOCOMOTION

861

TABLE
DATA ON AlA,

I
FROM

SUBJECTS*

PIN STUDIES

Subject

Age (Years) 24

Weight (Pounds) 185 150 180 168 160 150 160 162 165 175 152 165 175 170 152 180
(Feet)

Height (Inches) 4 2 9 112 0 10 1132 1 11 l3 11 10 9 3 2 Mochan;cal

Itniarks

6 6 5 5 6 5 .5 6 5 6 5 5 6 5 5 6

difficulties;

110

olata

2 3 4 6 7 8 9 10 ii
12

27 40 21 19 26 20 25 21 21 27 24 23 23 27 21

One
Pins

pin only;
miot

no data
properly; ono Pill bemit

set pin
pin

Excessive
Excessive

vibration
vibration

Excessive Excessive
Satisfactory

pin pin

vibration vibration
data

Gait

affected loosened;

by

pins;

no made

data

Pin

110 runs

Satisfactory Satisfactory

data
(lata

13 14 15 16 17 18 19 20 21 22 23 24 25 26

Satisfactory
Satisfactory

data data amputee; data pain; mio data

1101 pillS

Below-the-knee Satisfactory Bad limp;

no

piis

Bilateral amputoe; 110 pins Above-the-knee amput-co; 23

145
140 175 200 145 180 182 160 135 160 sul)jects and three

5
5 5 6 5 6 6 5 5 5 aliih)utces.

28 28
23 26 23

932 6 8 7 83 0 1 11 10 7

Limping; Removed Tibial Satisfactory Satisfactory Satisfactory Pin No I)ata No.

Satisfactory

one pin pimi No.

leg short No. 1; paimi 3 broken data data data

25
19

2 worked data usable

looso oyoio

27
28 29 *Tii.o,Iit.,_5ix

27
21 mio)rnial

comriploto

110)1 reduce:1

Test

Results
Twenty-six normal subjects, varying in age from nineteen to Of shown forty, iere

studied. vibration, nineteen

Twelve of

No

data

were

obtained single
from data

from pin
seven

the
iere

first and
not

seven
used

subjects
for the

because difficulties.
reasons

of excessive the
in Table

pin
I.

bending
subjects,

of pins,
the

settings,

mechanical for study

remaining pin data in

the

subjects

were

considered

satisfactory

and

analysis.

The

obtained which the transverse view, in and level

from the horizontal

photographs w-ere plotted on a rectangular axis represented time in seconds and t.he only with

co-ordinate vertical axis

system, represented

notation in degrees. Complete analysis has been made straight. and level walking. Data dealing walking, Discu-snion
Curves

of the data dealing with the top front and lateral views, in straight

will

be

presented

in subsequent

publications.

of Curves
obtained from motion-picture records of twelve normal subjects performing

straight, although
cases.

level walking, the magnitudes

as viewed from above, show-ed the of inward and outward transverse

same general pattern rotation varied in curves of all subjects changes occurred

of action, individual (Fig. 3) with nela-

had
VOL.

Detailed study and analysis of individual and composite to he based on the action of both legs, since the significant.
30-A, NO. 4. OCTOBER 1948

862

A.

S.

LEVENS,

V.

T.

INMAN,

AND

J.

A.

BLOSSEII

a-s

Zr.

THE

Jt)tRNAL

OF

HONE

AND

JOINT

SURGERY

THE

sE(;MENTs

OF

THE

LOWER

EXTREMITY

IN LoCOMoTIoN

563

bL

a.

-I;

I,

%OI,,

30-A,

NO.

4,

OCTOBER

194

864

A.

5.

IJEVENS,

I.

T. INMAN,
TABLE II

AND

J.

A.

BLOSSER

RANGE

OF

TRANSVERSE

HTArmoN

Polvis-Pin Subject 8 11 12 13
-

No.

lmniir-Pin
( I)egrees)

No.

Tibia-Pili
(I)egrees)

No,

(Degrees) 8.0 9.8 4.0 4.7

17.6 9.6 10.2 15.0

25.6 16.4 23.0 15.0

14 16 21
23 24 25 26 27

10.0 7.2
Notin 8.4 3.0 7.4 9.4 13.3

17.2 9.8
24.8 18.0 14.0 8.6 Loose 23.3

19.6 13.4
22.8 15.0 17.0 17.4 21.4 24.1

Maximum
Minimum Average

13.3 3.0 7.7

24.8 8.6 15.3

25.6 13.4 19.2

tion

to positions

of each

leg.

The

following

leg positions the floor; foot;

the

proved

to he of salient

importance:

1. Toe (of extremity 2. Foot. of swinging 3. Heel

with pins) leg abreast foot with pins) at toe-off;

leaving of other striking

4. Foot

(of extremity fiat, other

floor;

5. Foot flat and abreast of other 6. Heel (of extremity with pins) rrh time during ivhich the foot
w-hich

foot; rising and is in space with the

heel

is the floor

of other swing stance

foot- striking. phase, and phase.

the These

time two

d!uning phases the the

any
From

part.

of the

foot cycle

is in contact of one extremity.

is the

comprise moment cycle

increase

a w-alking

the time the foot of the pin-loaded it comes abreast of the other foot, rotation. At rate of rotation the time of the

extremity the pelvis,

leaves femur,
As

the floor (toe-off), until and tibia have start.e(l

of inward in the forward, and then

the feet. are abreast femur and the tibia.

of each other, the swinging until floor.

there is a definite leg continues to

move floor,

there is considerable increase in inward rotation a rapid increase until the other foot leaves the extremity leaves the
notation

the heel strikes the At the peaks of the This period then, is on the foot, is
the distal pants

curves, the pin-loaded from the time the foot

characterized by inward

receives the full weight of the body. floor until the full weight of the body
of all segment-s (pelvis, femur, and tibia),

rotating takes to the distal features minimum rotation

more place period segments

than until the

the

proximal of the forward more than related and

ones. pin-loaded and the

Beyond upward proximal

this extremity

point, again ones. full with In

outward leaves of the addition,

rotation the floor; the body.

of all segments and Here more is related again, significant the

foot

of increased rotate

acceleration

of t.hese curves are of w-eight-bearing starts i-ith full

to weight-bearing, terminates with and ends

in that inward weight-bearing, minimal

rotation starts with a wheneas outwand Rotation while just This on the
SURGERY

weight-bearing

weight-bearing. position is again is reached, suppressed

of the tibia is momentarily suppressed the pelvis and femur continue inward before the heel-rising is show-n in Figure The magnitude

just as the heel-striking rotation. Tibial rotation

position, while the pelvis and femur continue outward notation. 5-A for a single subject. and time of occurrence of the transverse rotation of the femur
THE JOURNAL OF BONE AND JOINT

THE

SEGMENTS

OF

THE

LOWER

EXTREMITY

IN

LOCOMOTION

865

TABLE
RELATIVE TRANSVERSE ROTATION

III
AT

Hm

AND

1NEE

JOINTS

DURING

STANCE

PHASE

Subject

Fommmr

with

Respect (Degrees) 7.4 6.3 8.6 10.1 7.4 6.4

to

Pelvis

Tibia

with

Respect (Degrees) 8.2 12.0 11.1) 6.2 6.6 9.4

to

Feniur

8 11 12 13 14 16 21 23 24 25 26 27 Average Stamidard deviation Pin No. Pin

No. 11.4 10.3 4.9

1 out

8.8 6.4 9.0 13.3 Pin No). 4.1 8.6 2.7 2 loose

2 loose

11.1 8.4 2.5

tibia

are

of particular

interest

to

the

clinician,

for

they

are

no

doubt

related

to the

locking and!,

mechanism in unlocking
twice in a-n

of the the
average

knee. knee,

When outward

the

knee

is locked, takes

inward place.

notation the

of the knee

femur locks

occurs; and

notation

Normally

unlocks

again
pictures

near

the

end

walking cycle, once during of the stance phase. This action

of normal subject-s.

the last portion of the swing phase and isas cleanly show-n in high-speed motion alt-ens locking
and

of a number

Cadence slower The

pelvis,

the

degree the is more

tibia,

to which knee apparent

as the

the to in the

doubleremain fast-er

locking ext-ended
cadences.

action during

occurs, the

in entire

that stance
notation

during phase.
of the

rates double
femur,

of walking

tends

Ranges

of transverse

as well

maximum,

minimum,

and

average

values

in each

case,

are

shown

in

Table

II.

These

values

were

obtained from the ill individual cases,

tO) have subject a concept. are show-n

individual curves. it is of importance

of ranges in Figure of these 5-A. mentioned,

While the magnitudes of transverse for the designer of mechanisms and

motions and ie average values.

rotation vary for the clinician

for a single

Curves

The

general
however,

pattern the
IV
OF THE

is similar knee-locking

to that effect

of the

curves

shown more dis-

in

Figure

3. As

previously

is shown

TABLE
MAGNITUDES OF TRANSVERSE ROTATION

PELVIS,

FEMUR,

AND

TIBIA

Transverse

Rotation

Relative

Transverse

Rotation

Member

Range (Degrees)

Average (Degrees)

Members

Rango (Degrees)

Average (Degrees)

Pelvis Feniur Tibia

*

3.0 8.6 13,4 Complete

31-A, NO.

to to to

13.3 24.8 25.6 shown

1948

7.7 15.3

Tibia

with

respect

4.1

to

13.3

8.7

to femur Femur 19.3 in Tables II and III. with respect 4.9 to 11 .4 8.4

to pelvis

data

are

VOL.

4, OCTOBER

866

A.

5.

LEENS,

V.

T.

INMAN,

AND

J. A. BLOSSE1(

I-

-f.

NOIiV1Od

THE

JOURNAl.

OF

BONE

AND

JOIINT

SURGERY

THE

SEOMENT5

OF

THE

LOWER

EXTREMITY

IN

LOCOMOTION

867

I-

V0)I.

30-A,

NO.

4,

O(TOHER

1948

868

A.

S.

LEVENS,

V. T. INMAN,

AND

J. A. BLOSSER

:z
Li 1 IZr biN.
WcV

iiiiiii-iiiii
cE 0 In

TIBIATO

#{231}FEMUR

-Z\-g. b-a
-

r;lj-

--

u_T

LiJO

0 RELATIVE
Relation of rotation,

891011 iN
6

12

13

$4

ROTATION
FIG.

DEGREES
rank (during stance phase).

in degrees,

to percentile

THE

JOURNAL

OF

BONE

AND

JOINT

SURGERY

THE

SEGMENTS

OF

THE

LOWER

EXTREMITY

IN

LOCOMOTION

869 near
plvis,

tinctly striking

in While

the
the

tibia!

curve.
to

Note
positions know

particularly
of the the ranges

the
stance

flattening
phase.

of the
rotation

curve of the

the

heelfemur,

an(!

heel-rising

it is important

of transverse

and tibia, it is even femur with respect

values may have

more significant to the pelvis,

upon the

to learn of the and of the tibia

design of artificial showing

magnitudes w-ith respect

limbs,

of relative notations of the to the femur, since such

as well as upon notations the of functions the tibia

a bearing

of the with

joints
Composite

from to the

a clinical
curves for

point
all

of view-.
relative transverse

subjects,

respect

femur

(knee

joint)

and

of the

femur there to the

with

respect

to the

pelvis

(hip)

aie presented during the

phase, and

in Figure period from

relative

4. In the former the feet-abreast

rotation of

instance position
approximately

is practically locked-knee
3.5 degrees

no relative rotation position of the swing

occurs between the

inward

locked-knee

position

and

the

full

weight-bearing

posit-ion.

Beyond

this

point

there

is a

slight outward relative transverse t-erval from the full weight-bearing followed by a very slight mw-and
relative outward rotation of

rotation of approximately 1.5 degrees, during the inposition to the time flexing at- the knee occurs. This is rotation of about 0.5 degree, after which there is a marked
approximately

3.5 with
minimal

degrees

as

the pelvis

foot

reaches

the

toe-off

position. The
interest.

relative
Throughout

rotation
the

of the
period

femur
from

respect
load

to the
to full

is also

of considerable
inward notation

weight-hearing,

of approximately position, outward

this ments discussion of the of

7 degrees rotation
results

occurs. of about
deals only

From the 6.5 degrees

with

fill! u-eight-bearing position takes place. It. should be

rotatory motions

to the reiterated various for the floor

toe-off that segcases when

transverse

of the and only

low-en extremity, as projected upon covering straight and level walking. In all subjects, the average relative notation
the foot is fixed on the floor-that is, during the

a horizontal of the
major

plane, with

tibia
portion

respect
of the

to the
stance

phase-may

be obtained from the tibia! pin matelv 7 degrees mw-and, during cycle per femur
individual relative

curve. The the interval 8 degrees (Fig. 3). rotation

magnitude of the relative from 7 per cent. to 17 per outward of the in the tibia with interval respect from

rotation is approxicent. of the walking 17 pen

femur

; and cent.
Ranges

it is approximately of the
of

cent. and

to 43 of the

w-alking cycle relative transverse to the

are show-n rotations

to the

wit-h

respect
cases,

pelvis,

transverse

as well as maximum, in Table IV. Here again, for the individual cases. to both designer for the

minimum, and average values for the variations exist in the magnitudes of A knowledge of the possible ranges and clinician, since such information limbs joints and of one improvement at the knee of artificial and hip

and

average

values

is of significance

will he helpful both in developing mechanisms in a bet-ten understanding of locomotion. Figure subject.
feet-abreast takes place

5-B During
(about

shows the

the stance

relative

transverse

rotations

position,

phase, in the interval from the heel-striking position to the very little transverse rotation of the tibia with respect to the femur 1 to 1 .5 degrees) As the knee locks, relative rotation increases inw-ardly
.

about knee
stance about

2.5 degrees, flexes to the During

phase, 10 degrees position,

follow-ed by a rapid toe-off position. interval

relative inward, during

outward

relative position
of the interval rotation

rotation to
femur

of about the with foot-flat respect

the latter 2 degrees

4 degrees position to the

position

as the of the pelvis is

to the

the
the

from

the

heel-striking
rotation by the a shorter relative

transverse follow-ed which

from is about

feet--abreast

action from
outwand

is then followed the feet--abreast

relative rotation

out-w-ard. This by mw-and relative rotation of about 2 degrees, during the interval position to the heel-rising position. From this point- on, fairly rapid
of approximately

10 degrees

occurs

as

the

toe-off

position

is

reached.
VOL. 30-A, NO. 4, OCTOBER 1948

870

A.

5.

LEVENS,

V.

T.

INMAN,

AND

J.

A.

BLOSSER

IZ

.-JZ

Zr.

c:btZ

,J:

1HI

JOURNAL

OF

BONE

AND

JOINl

sURo;ERY

THE

SEGMENTS

OF

THE

LOWER

EXTREMITY

IN

LOCOMOTION

871

Arm klo-motat

ion

mechanism

oluring

vitl

king.

lhe the by and pelvis, the tibia

nil)iltiOIi

relation
a.I1d

to of the

percentile

iank with iespect

of the

relative femur, for

nearly transverse

rotations is shown
of Iotation

of the
less lines, between

iemui

with
the

tespect
values shown

to

tibia

to the points

in Figure
than

6. ( )molinate
values

represent

percentages

of SuI)jects

having

magnitudes

corresponding
with respect

abscissae.
to femur

The
lie of relative

both
on

cases-femur
straight

with

respect.

to

pelvis

-eny

indicating tile tibia

a normal and femur

dist

pattern.
demonstration notation

A stiiking

at the knee joint is shown in Figures 7-A and 7-B. change from the flexed position of the leg to the the angular change between the targets.
SUMMARY AND

The fully

angular extended

dhsplacement position

caused is cleally

by the seen in

CONCLUSIONS

TraIlSvelse (Table Inward IV). Inward

rotations and!

of

the

pelvis, rotations

femur, of the

and

tibia segment-s

occur

in

all

normal

individuals to full weightto minimal of the

Outward!

are

relate(l

to weight-hearing.

bearing, load. foot modify The and

rotation takes and outward

place rotation

during the phase from minimal occurs (luring the phase from

weight-i)eaning fill! weight-bearing

in the

ro(ations of the low-er extremity appear their related ligamentous structures. upon the an(! rhythm

to be absorbed notations awkwardness

articulations

Restrictions placed! the synchrony

normal transverse of walking. The

will,

to varying degrees, an(l discomfort of a rotations motions. at the hip.

patient., required knee, and foot.,

At.

to wear a leg brace w-hich are no doubt due, in pant.,

does not provide to the restriction

for these of these

the

mechanisms

present time no prosthesis to provide for transverse rotation prevents and thus requires
1948

for t.he lower extremity rotatory motions, except

has purposely incorporated on an experimental basis. t.he behavior of movement of a of the.

Suppressing this normal extremity,

VOL. 30-A. NO. 4,

the prosthesis from approaching alterations in the normal pattern

OCTOBER

872 joints to torque occur stump. the-knee the by knee fixed the proximal is the This foot side amputees between amputee, position, hinge bars who to the least. the

A.

5.

LEVENS,

v.

T.

INMAN,

AND

J.

A.

BLOSSER

amputation. During and true there the

Relative weight-bearing socket, major restriction thigh of the to the

motion in the producing rotations lacer length and and

will stance

take phase,

place this

where motion limb. between at the

the

resistance will tend on belowand to the

stump

a most that the shape,

uncomfortable occur motion the

force In the trunk knee,

is particularly in addition

above-the-knee

suction-socket of rotatory

is further the

produced
sockets

connecting adequate

shank. the

In the
use

case

of below-theand but action of rotation, normal rotation

have

stump

of suction

an ankle mechanism may make it possible not only to provide for transverse also to do away with side hinge bars and lacers, w-hich tend to restrict the of the knee. The incorporation of a simple mechanism which provides for transverse sufficient magnitude, together may well constitute a major improvement of function and used on this project. All the very marked from high-speed nism. The the stance frames phase.

with a unit for the return of the foot to the normal contribution to both the comfort of the amputee synchrony in walking. An experimental mechanism
who

position, and the has been attested taken mechato

amputees

have

employed

this

mechanism

have

improvement in comfort. Figure motion pictures, of an amputee selected Attention for

8 shows reproductions using the experimental positions gap (A)

of frames, rotatory of the between

reproduction show the six salient should be called to changes in the

foot during the stops; foot. well

the width of the gap shows The ultimate incorporation become standard practice,

the amount of rotation occurring of this device, or modifications and may be advantageous in leg

betw-een the leg and the of it, in a prosthesis may braces.

CWdPLETE
BY WENDELL
ERNEST

DISLOCATION
J.
A.

oF
PENSACOLA,

THE

TALUS
FLORIDA, AND

NEWCOMB,
BRAY, M.D.,

M.D.,

LOUISVILLE,

KENTUCKY

This

case

is reported

because

of

its

rarity

and

because

it demonstrates and the policy

the

need

for

immediate the talus.

A man,
against

reduction,

the

possibility

of revasculanization,

of preserving

forty-five associated immediately. examination The about

foot,

years ankle

old, injury. showed

jumped

from

a moving

vehicle

and about

struck one hour

the

occipital no recollection the

port-ion injury, and anterior

of his of the

skull

the ground.
of his Physical

He suffered

a mild
He

cerebral
arrived at of over vertical portion

concussion
the the the axes. hospital right prominence. The

and,

therefore,

had

mecha-

nism

after

treatment to the

wa-s rendered
lateral malleolus. 90 degrees axis

inversion tense and

foot-

with The

a marked roentgenograms of this bone to the consisted pin

prominence revealed

skin the and carried

was

very

rotation fracture by over then

of the

talus
-zontal <Figs.

horizontal its posterior out the with was the

position and anterior

was transverse
fibula. No

of the

was lateral
under before the spinal pressure

to the horiwas noted

means portion the lateral that revealed of a of

1 and 2). The treatment, wire through tibia. Considerable forced rotated plane. Kirschner split 90

the

patient and

anaesthesia, on a Steinmann

of traction in the proximal direction,

Kirschner the it prominence, had The immediately horizontal

calcaneus, bone

countertraction anteroposterior

traction the degrees wire anteriorly. and displaced about

necessary into

in a posteromedial plane. Roentgenograms

vertical
pin week

axis, while
were removed,

travelling and

the
a toe-to-groin

90 degrees
plaster

of displacement
was applied. This

in

the was

Steinmann After one

the plaster

was

changed;
THE

at this time a small

JOURNAL OF BONE AND

necrotic
JOINT

area was
SURGERY