. Modern surgery, general and operative. neatly padded were placed about the metacarpal, Fractures of the Phalanges 665 one posteriorly in the interosseous space, one along the outer border, and thethird over the thenar eminence. These extended from well above the meta-carpal bone to the first phalangeal joint. They were fastened tightly in place bytwo strips of adhesive plaster. Traction was then exerted on the thumb andmaintained by strips of adhesive plaster passing about the first phalanx andthe projecting ends of the three skewers. This dressing was reinforced by arectangular cardboard sp
. Modern surgery, general and operative. neatly padded were placed about the metacarpal, Fractures of the Phalanges 665 one posteriorly in the interosseous space, one along the outer border, and thethird over the thenar eminence. These extended from well above the meta-carpal bone to the first phalangeal joint. They were fastened tightly in place bytwo strips of adhesive plaster. Traction was then exerted on the thumb andmaintained by strips of adhesive plaster passing about the first phalanx andthe projecting ends of the three skewers. This dressing was reinforced by arectangular cardboard splint. Accurate coaptation and sufficient traction toovercome the deformity and muscular action are most necessary in the treat-ment of this fracture. Slate pencils or small lead pencils can be used in placeof the wooden skewers. The soapstone slate pencils are less brittle than theordinary kind. Fracture of the Sesamoid Bones of the Thumb.—There are two sesamoidbones on the palmar surface of the metacarpophalangeal articulation in the. Fig. 391.—Intracapsular fracture of the hip (authors case). thumb, lying in the tendons of the flexor brevis pollicis, and one in the palmarsurface of the interphalangeal joint of the thumb. Skillern (Annals ofSurgery, 1915, Ixii) reports a case of fracture of the ulnar sesamoid of thethumb and says three cases have been reported previously. The conditioncauses swelling of the thumb, ecchymosis of the thenar eminence, and acutetenderness at the base of the first metacarpal bone. The treatment isimmobilization for four weeks and then passive motion and massage. Fractures of the Phalanges.—The phalanges are often broken. The frac-ture may be compound. The cause usually is direct force. Symptoms.—Fracture of a phalangeal bone is indicated by pain, tenderness,bruising, crepitus, and mobility, with very little or no displacement. Treatment.—If the middle or distal phalanx is broken, mold on a trough-like splint of gutta-percha or of pasteboa
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