Wrist and Hand. 103 



affect this bone more than any other; (3) that to it more 

 ligaments are attached and there would, therefore, be 

 greater chance for it to be injured, and, lastly, (4) that 

 the examination of the skiagraphs of a number of cases of 

 tuberculosis of the wrist joint showed, that in every one 

 of them, the disease had started in the os magnum. 



Operative Work on the Hand and Wrist. 

 In whitlozv make an incision down through the diseased 

 structures on either side of the middle line of the ringer. 

 Do not delay, since the septic processes spread rapidly, 

 and the only hope of saving the phalanx, or even the fin- 

 ger, will consist in early incision. 



Should the inflammation involve the synovial sheaths 

 for the index, middle or ring fingers, it will be limited 

 above at the necks of the metacarpal bones; but, as ex- 

 plained in the preceding section, if the sheaths for the little 

 finger and thumb be involved, there is a strong probability 

 of the disease spreading up to the synovial sacs in the 

 palm, so that, if neglected, there is no telling where the 

 effects may end destruction of the flexor tendons, in- 

 volvement of the bones, septicsema, etc., hence the neces- 

 sity for early incision. Incise a palmar abscess in the 

 palm, or, if pus be above the annular ligament, at the 

 front of the wrist. In the latter situation make an incision 

 about one-quarter of an inch internal to the tendon of the 

 palmaris longus, thus avoiding the ulnar artery which lies 

 half an inch internal to this tendon, and the median nerve 

 lying immediately beneath the tendon. In the palm, make 

 a short, deep incision, bearing in mind the. situation of the 

 superficial palmar arch. Hilton's method is not as ser- 

 viceable here, as elsewhere, since the strong dense palmar 

 fascia opposes the divulsion of the tissues necessary for 

 the success of this method. In Dupuytren's contraction 

 the fibres and the processes of the palmar fascia may be 



