1. There are two forms of disease comprised under the name “contraction
of the palmar fascia,” the one traumatic in origin, occurring at all
ages, and not tending to spread far beyond the seat of injury; the other
unassociated with obvious traumatism, tending to multiplicity of lesion,
and almost confined to middle and advanced life.
2. The latter condition, the true “Dupuytren’s contraction,” is not,
strictly speaking, a contraction of the palmar fascia, but consists
of a chronic inflammatory hyperplasia, commencing in the corium and
subcutaneous connective tissue, involving secondarily the palmar fasciæ,
and tending to the formation of dense bands of cicatricial tissue which
replace the normal structure.
3. It does not appear to be especially connected with pressure or
friction of the palm by tools or other objects employed in manual
occupations, but is probably caused by infective organisms which gain
admission through epidermic lesions, usually located over the prominent
heads of the metacarpal bones.
4. It is almost essentially a disease of middle and advanced age, more
common in men than in women, occurring in all classes, tending to
progress slowly through a long course of years, and liable to recurrence
after operation.
5. It is connected with a special susceptibility, inherited or acquired,
which cannot yet be accounted for or expressed in any known terms; but
neither gout, rheumatism, rheumatoid arthritis, nor any other of the
ordinary constitutional ailments has been proved to have any causative
relation to the disease.
6. Cicatricial deformities of the digits resulting from burns and other
severe injuries are often of a very distressing character, and especially
those which prevent opposition of the thumb to the fingers. When the
joints are not destroyed, the utility of the member may generally be
restored by well-devised plastic measures, the new material being either
an epidermic graft, or a skin flap taken from a convenient portion of the
surface; but it is useless to lay down laws in detail for the treatment
of these conditions, as the variations in the extent and position of the
loss of substance are so great that only the ingenuity of the operator
can guide him in the application of the general principles of plastic
surgery.
CONTRACTION OF THE FINGERS DUE TO DEVELOPMENTAL IRREGULARITIES IN THE
BONY AND LIGAMENTOUS ELEMENTS OF THE ARTICULATIONS.
There are certain affections of the fingers which have hitherto attracted
little notice, but are interesting on account of their relationship to
deformities of much greater frequency in the lower extremity. These are
conditions of abnormal flexion and of lateral deviation of the phalanges
at the inter-phalangeal articulations, the first of which corresponds
exactly to the well-known deformity of the foot called “hammer toe.”
[Illustration: FIG. 6.
“Hammer Finger.”]
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