The precision with which it is possible to reduce a Pott's fracture by manipulation becomes a source of pleasure once the surgeon understands the mechanics of this reduction. My own satisfaction is increased when I recall the uncertainty of my own early attempts to reduce this fracture-dislocation and how I was once dependent on the X-ray as on a ‘lucky dip.’

The problem in treating a Pott's fracture is not so much how to reduce the fracture but how to make sure that it will stay reduced. I shall endeavour to indicate when I think it is dangerous to persist with closed reduction and when operative aid should be invoked.

Operative treatment of the Pott's fracture is not a procedure to be encouraged as a routine, because there are special complications of operative treatment quite as serious as the defects of closed treatment. In the ordinary Pott's fracture the functional and anatomical results of a skilful closed reduction should be perfect. Even if a small posterior marginal fragment remains displaced, the ankle possesses a latitude for recovery of function which is often astonishing. The open reduction of this fracture-dislocation can be a matter of considerable technical difficulty; to secure adequate exposure in the cramped space available may impair the blood supply of a detached fragment. If for any reason open reduction should be attempted, nothing less than a ‘hair-line’ restoration should be regarded as justifying it; incomplete reduction after open operation must be regarded as an error of judgment. If open reduction is considered imperative, then the minimum of metallic ‘hardware’ should be used.