In a sprain the normal relations of the styloid processes and other bony points about the wrist are unaltered, and there is no radial deviation of the hand, as in Colles' fracture. The most marked swelling is over the line of the articulation on the anterior and posterior aspects of the joint. There is usually some effusion into the sheaths of the tendons passing over the joint, and in some cases on moving the fingers a peculiar creaking, which may simulate crepitus, can be elicited. There is marked tenderness on making pressure over the line of the joint, as well as over one or other of the collateral ligaments, depending upon which ligament has been over-stretched or torn. Movements that tend to put the damaged ligaments on the stretch also cause pain. It has to be borne in mind, however, that in many cases of Colles' fracture there is extreme tenderness on pressing over the ulnar styloid and medial ulno-carpal ligament, as these structures are frequently injured as well as the radius, but the point of maximum pain and tenderness is over the seat of fracture of the radius. In all doubtful cases the X-rays should be employed to establish the diagnosis. The _treatment_ consists in the immediate employment of massage and movement, supplemented by alternate hot and cold douches, on the same lines as in sprains of other joints. INJURIES OF THE FINGERS #Fracture.#--_Fractures of the metacarpals of the fingers_ are comparatively common. When they result from direct violence, such as a crush between two heavy objects, they are often multiple and compound. Indirect violence, acting in the long axis of the bone and increasing its natural curve, such as a blow on the knuckle in striking with the closed fist, usually produces an oblique fracture about the middle of the shaft, the proximal end of the distal fragment projecting towards the dorsum. Apart from this there is little deformity, as the adjacent metacarpals act as natural splints and tend to retain the fragments in position. A sudden sharp pain may be elicited at the seat of fracture on making pressure in the long axis of the finger; and unnatural mobility and crepitus may usually be detected. These fractures are readily recognised by the X-rays. Firm union usually results in three weeks. The shaft of the _metacarpal of the thumb_ is frequently broken by a blow with the closed fist. The fracture is usually transverse, and situated near the proximal end of the shaft; frequently it is comminuted, and in some instances there is a longitudinal split.