Recurrent Dislocation of the Ankle-Joint, due to Rupture of the External Ligament

'HE sprain of the external ligament of the ankle-joint is (lue to the sudlden rversion of the joinlt, wvith adduction of the fore-foot, whIilst the force is the nmbination of momnenitum aind bodyweight. The injury to the ligramietnt mav ~nge from the tearing of a few fibres to the complete rupture of the fasciculi. Onrecognise(l, or classe(d as a simple sprain, such an injury leads to chronic ~stability of the anikle-joint, an(l dlislocation of the astragalus from the mortice the joint occurs o00 slight provocation. Ihe nornial rangc of m-novemient at the kle is antero-posterior. Inversion takes place at the subastragaloid and mild-sal joints. Ordinary N-rays of the ailkie will show nio abnormality, b)ut if the anlkc be hel(d forcible inversion, the nlorti(ce of the joint wvill be seeni to have ()pened oLut. is injury is one especially likely to be seci cluring war, when severc inx-crsion rains are connmon undler active service con(litions in the fieldl. The folloxvinig case report is typical, and illustrates the clinical signs of the ndition Sergeaniit J., a-e>d 33 years, rc ridar soldier, R.A., dlescrilbe(l an accident ten rs previously, when he twisted the left ankle violently plaving hockey. He was iged to leaxe the field, and xx'as treatedl by rest and bed for four days and(l col(d mpresses. No X-rav was takell, and the anikle was previously stable. He stopped playing es for son01e wveeks, andl then tried again, wvearing, ani elastic stockling. He nd that the anikle gave out on slight provocation, hut that tile after-eflect of se sprains was never as severe as after the first occasion. He limitedl llimlself ordinary cluties, but sullerecl nlucll inconvenience. In 1940, wlhilst acting as a nery instructor, the con(litioni became habitual, andl he was unable to hlurry er rough grounld or to walk in the dark. He reported sick on several occasions, twas nexer X-raved, an(xwas finally sent to hospital xwith a note stating that was of no ulse to his unit, and(a thinly-veiled inference that he wvas conisidered malingerer.