radius. The thumb is absent.

(Photograph lent by Sir George T. Beatson.)]

#Madelung's Deformity of the Wrist.#--In 1878, Madelung called
attention to a deformity also called sub-luxation of the hand, in
which the lower articular surface of the radius is rotated so that it
looks towards the palm; there is palmar displacement of the carpus,
and the lower end of the ulna projects on the dorsum. The cause of the
condition is obscure, but it is met with chiefly in young women with
slack ligaments, whose laborious occupation or athletic pursuits
subject the hand and wrist to long-continued or repeated strain. It is
as frequently unilateral as bilateral and may recur in successive
generations. There is a good deal of pain, the grasping power of the
hand is impaired, and dorsiflexion is considerably restricted. The
deformity disappears on forcible traction, but at once reappears when
the traction is removed. A wristlet of poroplastic or leather
extending from the mid-forearm to the knuckles is moulded to the limb
in the corrected position, and is taken off at intervals for massage
and exercises.

When _operative treatment_ is called for, it takes the form of
osteotomy of the radius and ulna about an inch or more above their
articular surfaces.

#Congenital dislocation of the wrist# is rare.

#Deformities of the Fingers.#--Various forms of _congenital
dislocation_ of the fingers are met with, but they are of little
clinical importance, as they interfere but slightly with the
usefulness of the digit affected.

_Congenital lateral deviation of the phalanges_ is more unsightly than
disabling; it is met with chiefly in the thumb, in which the terminal
phalanx deviates to the radial or to the ulnar side in extension; the
deviation disappears on flexion.

_Congenital contraction of the fingers_ is comparatively common. It is
an inherited deformity, and is often met with in several members of
the same family. It most frequently affects the little or the ring and
little fingers (Fig. 172), and is usually bilateral. The second and
third phalanges are flexed towards the palm; the first phalanx is
dorsiflexed, this being the reverse of what is observed in Dupuytren's
contraction. Duncan Fitzwilliams suggests that it should be called
"hook-finger," and that it is probably due to imperfect development of
the anterior ligament of the first inter-phalangeal joint. He has
observed it in association with laxity of the ligaments of the