20, 1 Yap and Pineda: Two Cases of Ectrosyndactyly 3 
space between the third and fourth. The proximal ends of the 
metacarpals, except that of the second which articulates only 
with the greater multangular, appear normal in position and 
connections, while their distal ends or heads show considerable 
displacement. The head of the second is in contact with that 
of the first; the heads of the fourth and fifth are also in contact 
with each other. 
The phalanges of the thumb are normal. There are no pha- 
langes in the second metacarpal. The third metacarpal shows 
only the proximal phalanx considerably lengthened and dis- 
placed transversely, wedged in between and articulating with 
the head of the third and the base of the proximal phalanx of 
the fourth metacarpal. This phalanx is shaped like a meta- 
carpal, shows evidence of a fracture laterally, and seems to be 
responsible for the divergence of the third and fourth metacar- 
pals. The phalanges of the fourth and fifth are normal, except 
for the articulation of the proximal end of the first phalanx of 
the fourth with the crossed phalanx of the third as mentioned 
above. (Plate 1, fig. 2.) 
Left hand.—The left hand also has three digits, the same as 
in the right. The ring and small fingers, however, are hot syn- 
dactylized, and the thumb is apparently normal. (Plate 2, 
fig. 1.) 
The carpals are normal. 
The metacarpals are complete and distinct. The first and 
the fourth are shorter than normal, the second is slenderer and 
the fifth is larger. The fourth metacarpal curves toward the 
ulnar side, touches the fifth, and leaves a considerable space 
between it and the third. 
The phalanges of the first metacarpal are normal. The 
second shows only a rudimentary proximal phalanx, displaced 
medially. The third has only the proximal phalanx which is 
bent transversely medially, fusing with the middle of the prox- 
imal phalanx of the fourth, and acts as a wedge which pushes 
the fourth metacarpal toward the ulnar side of the hand. The 
fourth metacarpal shows a union of the proximal and middle 
phalanges, the resulting bone being displaced laterally and 
joined with the proximal phalanx of the third, as mentioned 
above. The distal phalanx is normal. The last metacarpal also 
shows a distorted union between its first and middle phalanges, 
while its distal phalanx is normal. (Plate 2, fig. 2.) 
Right foot—The right foot exhibits only two toes, the great 
toe and the fifth, each provided with a nail, and with their distal 
