disappears, and the
skin and fascia thus brought into contact become fused. The tendons
and their sheaths are not implicated; they are found lying deeply in
the concavity of the curve of the flexed digit. There is no pain, but
the grasp of the hand is interfered with, the patient is unable to
wear an ordinary glove, and he may be incapacitated from following his
occupation.

The condition is easily diagnosed from congenital contraction by the
fact that in the latter the proximal phalanx is dorsiflexed.

_Treatment._--When seen in the initial stage, contraction may be
prevented by passive movements of the finger and by massage of the
indurated fascia; we have observed cases in which these measures have
held the malady in check for many years, but when flexion has already
occurred, they are useless, and according to the social position,
habits, or occupation of the patient, the condition is left alone or
the deformity is corrected by operation.

Adam's operation consists in multiple subcutaneous division of the
contracted fascia in the palm and of its prolongations on to the
finger; in addition to dividing the fascia, the tenotomy knife should
be used also to separate the skin from the fascia. The finger is then
forcibly extended, and a well-padded splint secured to the hand and
forearm. The skin on the palmar aspect opposite the first
inter-phalangeal joint may give way when the finger is extended;
should this occur, the resulting gap may be covered by a skin graft.

After healing has occurred, massage and movements must be persevered
with, and a splint (Fig. 174) worn at night, as there is an inveterate
tendency to recurrence of the contraction. In view of this tendency
there is much to be said in favour of the radical operation which
consists in removal of the fascia by open dissection. Owing to the
long time required for healing and the sensitiveness of the scar, the
results of excision of the fascia are sometimes disappointing. Greig
has obtained good results by resecting the head of the metacarpal
bone. When the little finger is completely flexed towards the palm it
may be amputated, as it is always in the way.

[Illustration: FIG. 174.--Splint used after Operation for Dupuytren's
Contraction.]

#Supernumerary Fingers (Polydactylism).#--These may coexist with
supernumerary toes, and the condition is often met with in several
members of the same family. Sometimes the extra finger is represented
by a mere skin