[Illustration: FIG. 127.--Advanced Tuberculous Disease in region of
Ankle. The ankle-joint is ankylosed, and there is a large sequestrum in
the calcaneus.
(Specimen in Anatomical Museum, University of Edinburgh.)]
If an exact diagnosis is made at an early stage of the disease--and this
is often possible with the aid of X-rays--the affected bone is excised
sub-periosteally or its interior is cleared out with the sharp spoon and
gouge, the latter procedure being preferred in the case of the
_calcaneus_ to conserve the stability of the heel. When several bones
and joints are simultaneously affected, and there are sinuses with
mixed infection, amputation is usually indicated, especially in adults.
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