Drop Wrist from Anterior Poliomyelitis.—In this condition the capacity of extending the fingers is deficient or absent. Recovery can be confidently predicted if, on still further flexing the fingers, they can be voluntarily extended towards the point from which they are flexed (Tubby and Jones). Considerable improvement may result from fixing the hand by means of a splint in the attitude of dorsal flexion. The splint is removed at frequent intervals to allow of massage and other treatment being carried out, and it has usually to be worn for a period of one to two years. In some cases recourse should be had to arthrodesis.
Fig. 170.—Congenital absence of Left Radius and Tibia in a child æt. 8.
(Mr. D. M. Greig's case.)
In spastic paralysis the most pronounced deformity is flexion of the forearm and pronation and flexion of the hand ([Fig. 166]). Gradual extension at the wrist may be brought about by the use of a malleable splint, in which the angle is gradually increased, over a period of at least twelve months. Failing success by this method, operation may be had recourse to, and this consists in lengthening of tendons, and tendon transplantation. Tubby has devised an operation for converting the pronator radii teres into a supinator, and Robert Jones another in which the flexors of the carpus are made to take the place of the extensors. “These operations, combined if necessary with elongation of the flexors of the fingers, pave the way for diminution of the angle of flexion at the elbow, lessening of the pronator spasm, increase of the supinating power, reduction of the carpal flexion, and addition to the extensor power at the wrist” (Tubby and Jones).
Congenital Club-hand.—This rare deformity corresponds to congenital club-foot, and probably arises in the same way. The hand and fingers are rigidly flexed to the ulnar or radial side, so that the patient is incapable of moving them. Treatment is carried out on the same lines as for club-foot.
A deformity resembling this, acquired club-hand, is brought about when the growth of either of the bones of the forearm has been arrested as a result of disease or of traumatic separation of its lower epiphysis. The hand deviates to the side on which the growth has been arrested—manus valga or vara. The treatment consists in resecting a portion of the longer bone.
Fig. 171.—Club-hand, the result of imperfect development of radius. The thumb is absent.
(Photograph lent by Sir George T. Beatson.)