hich 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 anaesthetise 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.

This dislocation is usually produced by extreme dorsiflexion of the
thumb, whereby the volar accessory (palmar) and the collateral
ligaments are torn from their metacarpal attachments, the phalanx
carrying with it the volar accessory ligament and sesamoid bones. The
head of the metacarpal passes forward between the two heads of the
short flexor of the thumb, and the tendon of the long flexor slips to
the ulnar side. The phalanx passes on to the dorsum of the metacarpal,
where it is held erect by the tension of the abductor and adductor
muscles.

The attitude of the thumb is characteristic. The metacarpal is
adducted, its head forming a marked prominence on the front of the
thenar eminence, and the phalanges are displaced backwards, the
proximal being dorsiflexed and the distal flexed towards the palm.

Many explanations of the difficulty so often experienced in reducing
this variety of dislocation have been offered, but the consensus of
opinion seems to be that it is due to the interposition of the volar
accessory ligament and the sesamoid bones between the phalanx and the
metacarpal, and that this is most frequently the result of ill-advised
efforts at reduction. In some cases the tension of the long flexor
tendon may be a factor in preventing reduction, but the
"button-holing" by the short flexor is probably of no importance.

Reduction is to be effected by flexing and abducting the metacarpal
while the phalanx is hyper-extended and pushed down towards the joint
and levered over the head