ON EXCISION OF THE WRIST 1-OR CARIES 



433 



which it is most serviceable for opposition to the fingers. For if it be pushed 

 upwards by resting on a board or cushion, it will be apt to retain permanently 

 its unnatural attitude ; its basis of support, removed in the operation, being 

 reproduced in accordance with its altered circumstances. For the same reason, 

 the piece of cork on which the hand rests should be well hollowed to receive the 

 ball of the thumb. The thumb itself is apt to become drawn, in time, towards 

 the index-finger, which would greatly impair its usefulness ; but this is readily 

 avoided b}^ taking the precaution of keeping the thumb, from the first, completely 

 extended by a substantial pad of cotton in the angle between it and the fore- 

 linger, the pad being of course removed once every day for exercise of the joints. 

 Pronation and supination, also, must not be long neglected ; and as the 



Fig. 5. — a represents the splint, of which A B is the wooden 

 part ; C, the piece of cork to support the hand ; D, the transverse 

 bar of cork beneath ; E, the ledge of gutta-percha for the ulnar 

 border of the hand to rest on ; F, another ledge of gutta-percha. 

 b shows the limb bandaged to the splint. 



new wrist acquires firmness, flexion and extension, abduction and adduction, 

 should be occasionally encouraged. 



As to the length of the period during which passive motion may be required, 

 the rule must be to continue it till the disposition to contract adhesions finally 

 ceases, and this may be after a few weeks or not till months have elapsed. 



When the patient leaves his bed and carries his arm in a sling, the weight 

 of the hand will make it gradually droop to the ulnar side, unless it is properly 

 supported. This is conveniently done by affixing two ledges of gutta-percha 

 (Fig. 5, E and F) to the ulnar side of the splint — one for the border of the hand 

 to rest on, and another, towards the upper part of the forearm, to keep the splint 

 from shifting laterally 



When the hand acquires strength enough to bo useful, more free [Aay for 

 the fingers should be allowed by cutting off the jiart of the si>lint on which they 



