rop Wrist from Anterior Poliomyelitis.#--In this condition the
capacity of extending the fingers is deficient or absent. Recovery can
be confidently predicted if, on still further flexing the fingers,
they can be voluntarily extended towards the point from which they are
flexed (Tubby and Jones). Considerable improvement may result from
fixing the hand by means of a splint in the attitude of dorsal
flexion. The splint is removed at frequent intervals to allow of
massage and other treatment being carried out, and it has usually to
be worn for a period of one to two years. In some cases recourse
should be had to arthrodesis.

[Illustration: FIG. 170.--Congenital absence of Left Radius and Tibia
in a child aet. 8.

(Mr. D. M. Greig's case.)]

In _spastic paralysis_ the most pronounced deformity is flexion of the
forearm and pronation and flexion of the hand (Fig. 166). Gradual
extension at the wrist may be brought about by the use of a malleable
splint, in which the angle is gradually increased, over a period of at
least twelve months. Failing success by this method, operation may be
had recourse to, and this consists in lengthening of tendons, and
tendon transplantation. Tubby has devised an operation for converting
the pronator radii teres into a supinator, and Robert Jones another in
which the flexors of the carpus are made to take the place of the
extensors. "These operations, combined if necessary with elongation of
the flexors of the fingers, pave the way for diminution of the angle
of flexion at the elbow, lessening of the pronator spasm, increase of
the supinating power, reduction of the carpal flexion, and addition to
the extensor power at the wrist" (Tubby and Jones).

#Congenital Club-hand.#--This rare deformity corresponds to congenital
club-foot, and probably arises in the same way. The hand and fingers
are rigidly flexed to the ulnar or radial side, so that the patient is
incapable of moving them. Treatment is carried out on the same lines
as for club-foot.

A deformity resembling this, _acquired club-hand_, is brought about
when the growth of either of the bones of the forearm has been
arrested as a result of disease or of traumatic separation of its
lower epiphysis. The hand deviates to the side on which the growth has
been arrested--_manus valga_ or _vara_. The treatment consists in
resecting a portion of the longer bone.

[Illustration: FIG. 171.--Club-hand, the result of imperfect
development of