Enedke (neut. Zeit. f. Chin, Nov., 1902).
Osteotomy may be necessary to ob viate some of its discomforts and dis abilities.
Hammer-toe.
This is a permanent contraction or cramping of one or more toes in which they project up above the rest. Corns form on top, owing to rubbing of the shoe.
[Hammer-toe usually affects the sec ond toe. While it is doubtless true that some infants are born with a decided tendency to this deformity, it is still possible that it is due to narrow-toed shoes of the parents. T. G. AloRTos, Assoc. Ed., Annual, '80.] The most effective and surest remedy is to amputate the toe at the metacarpal joint. This may seem radical, but, while, by dividing the flexor and extensor tendons and even the lateral ligaments, the toes may be straightened, still in a few months the deformity is apt to recur.
If resection of the joint is performed it is apt to leave a wobbly, loosely attached, toe which tends either to be pushed up above the level of the other toes or else to become caught under one of the toes on either side and forni a condition of affairs as annoying as was the original affection.
Webbed Fingers.—When these are congenital they may be cured by raising a wedge-shaped flap from the base of the dorsal aspect of the web and slitting up the remainder. The flap is then turned in between the fingers and sutured in the palm and the raw surfaces on the sides of the fingers approximated as much as possible.
The essential part of all operations for this affection is to get a healthy strip of skin to heal nicely in the base of the web, thus preventing a cicatricial band forming at this point.
term is applied to a rare condition of the hand correspond ing to club-foot. It may be congenital, as a result of defective development, or may be caused by any traumatism ca pable of inducing paralytic contraction. The congenital variety is usually asso ciated with deformity of the lower end of the radius or ulna and with other congenital malformations. The hand may be fixed in extreme flexion or ex tension, or it may be deviated laterally, thus constituting varieties resembling those observed in club-foot. In the majority of cases, however, the hand is drawn toward the radial side and flexed.
— Passive motion and persistent efforts to place the fingers and hand in their normal position, a reten tive apparatus or plaster dressing being used, are sometimes followed by im provement. Frictions and galvanism of the muscles involved tend to assist the curative process. Tenotomy does not enjoy the confidence of surgeons, as a rule, and is thought by many to be more harmful than beneficial.
In club-hand, section of the tendons, ligaments, or fascia may be necessary if the case is not seen in the early stages. If the flexor tendons have to be divided, it would seem better to operate in the forearm instead of the hand, and to split the tendons longitudinally, and, after having gained the required additional length by sliding the ends past each other, to suture them together once more. Bi u t (Annales d'Orthop6(lie, May, '93).