Manual of Surgery Volume Second: Extremities—Head—Neck. Sixth Edition.Thomson, Alexis
Science
Manual of Surgery Volume Second: Extremities—Head—Neck. Sixth Edition.
Thomson, Alexis
Surgery
The _treatment_ consists in reducing the fracture by extension in the
attitude of full abduction and applying an accurately fitting pad over
the extremity of the displaced bone, maintained in position by a light
angular splint. This splint is first fixed to the extended and
abducted thumb, and while extension is made by pushing it downwards
the upper end is fixed to the wrist (Fig. 54 A). The apparatus is worn
for three weeks, being carefully readjusted from time to time to
maintain the extension and abduction. A moulded poroplastic splint
added on the same principle may be employed, and is more comfortable
(Fig. 54 B). Excellent results are obtained after reduction of the
displacement, by massage and movement from the first, and the support
merely of a figure-of-eight bandage (Pirie Watson).
[Illustration: FIG. 54.--A. Splint applied as used by Bennett. B.
Poroplastic Moulded Splint for Bennett's Fracture.]
#Fractures of phalanges# usually result from direct violence, and on
account of the superficial position of the bones, are often compound,
and attended with much bruising of soft parts. Force applied to the
distal end of the finger may also fracture a phalanx. The proximal
phalanges are broken oftener than the others. The deformity is usually
angular, with the apex towards the palm, and if union takes place in
this position, the power of grasping is interfered with. Unnatural
mobility and crepitus can usually be recognised, but, on account of
the swelling and tenderness, the fracture is apt to be overlooked.
Firm union takes place in two or three weeks. In oblique and
comminuted fractures, union may take place with overlapping, producing
a deformity which may prevent the wearing of a glove or of rings. In
compound fractures, non-union sometimes occurs, and causes persistent
disability. In doubtful cases radioscopy renders valuable aid, as the
parts are readily seen with the screen.
_Treatment._--Early movement and massage are all-important. The
contiguous fingers may be utilised as side splints, and a long palmar
splint projecting beyond the fingers is applied. In oblique and
comminuted fractures it may be necessary to anæsthetise the patient to
effect reduction. When it is particularly desirable to avoid
deformity, an open operation may be advisable.
#Dislocation.#--_Dislocation of the Metacarpo-phalangeal Joint of the
Thumb._--The commonest dislocation at this joint is a _backward_
displacement of the proximal phalanx, which may be complete or
incomplete. Its special clinical importance lies in the fact that much
difficulty is often experienced in effecting reduction.
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