Reduction is easily effected by making traction on the phalanges and carrying out movements of flexion and extension. The deformity, however, is liable to be reproduced unless a retentive apparatus is securely applied.
Dislocation of the thumb to one or other side is rare.
Dislocations of the metacarpo-phalangeal joint of the fingers may be backward or forward. They are less common than those of the thumb, but present the same general characters. In the backward variety the same difficulty in reduction occurs as is met with in the corresponding dislocation of the thumb, and is to be dealt with on the same lines.
Inter-phalangeal Dislocation.—The second and the ungual phalanges may be displaced backwards, forwards, or to the side. The clinical features are characteristic, and the diagnosis, as well as reduction, is easy. These dislocations are frequently the result of machinery accidents, and being compound and difficult to render aseptic, often necessitate amputation.
Persistent flexion of the terminal phalanx of the thumb or fingers (drop or mallet finger) may result from violence applied to the end of the digit when in the extended position—as, for example, in attempting to catch a cricket-ball. The terminal phalanx is flexed towards the palm, and the patient is unable to extend it voluntarily. A palmar splint is applied securing extension of the distal joint for three or four weeks. If the deformity has been allowed to occur it can only be corrected by an open operation, suturing or tightening the extensor tendon at its insertion into the base of the terminal phalanx.
CHAPTER VI
INJURIES IN THE REGION OF THE PELVIS, HIP-JOINT, AND THIGH
- [Fractures of Pelvis: Varieties]
- —[Injuries in Region of Hip]:
- [Surgical anatomy];
- [Fracture of head of femur];
- [Fracture of neck of femur];
- [Fracture below lesser trochanter]
- —[Dislocation of Hip: Varieties]
- —[Sprains]
- —[Contusions]
- —[Fracture of Shaft of Femur].
Fracture of the Pelvis
For descriptive as well as for practical purposes, it is useful to divide fractures of the pelvis into those that involve the integrity of the pelvic girdle as a whole, and those confined to individual bones.
In all, the prognosis depends upon the severity of the visceral lesions which so frequently complicate these injuries, rather than upon the fractures themselves.