R.Clement Lucas
1885 The Lancet  
SENIOR ASSISTANT SURGEON TO GUY'S HOSPITAL, SURGEON TO THE EVELINA HOSPITAL FOR CHILDREN. THIS injury must be extremely rare, and I am unable to find any recorded case. For this reason it may be well to report an instance, the exact character of which was determined with certainty by examination under chloroform. The injury resembles dislocation of the base of the metacarpal bone, and I can imagine that it might be very readily overlooked, especially by such as may have become oblivious to the
more » ... xceptional arrangement of ossific centres, which distinguishes this metacarpal bone from its fellows and brings it into alliance with the phalanges. C. W-, aged sixteen, sought advice in the surgery of Guy's Hospital on March 5th, 1885. He stated that he had been playing with another lad, and that he had fallen with his hand bent under him, the weight of his body being received upon the outer side of the left thumb. The thumb was somewhat bruised and painful, andhe was unable to move or use it without great pain. There was a projection in a direction outwards and backwards at the base of the metacarpal bone, which at first sight appeared to be caused by a dislocation at the carpo-metacarpal joint. The case had been seen by the dresser, and he had attempted to draw the projecting bone into place; and afterwards by Mr. Targett, the house-surgeon. Mr. Targett, being also in doubt as to the nature of the case, requested me to examine it. Tracing the metacarpal bone down towards its base, I found that it terminated in a projection situated on the outer and posterior aspect of the thenar eminence. It could be pressed into place without eliciting crepitus, and had a tendency to recur to its former position. Seiz ing the trapezium between the finger and thumb of one hand and the metacarpal bone in a similar way with the other. 1 found that the site of movement was too low to be in the joint between these bones. There being no true crepitus elicited when moved to and fro in this manner, it was evident that the deformity must be due to a separation of the epiphysis, and not to a fracture of the bone. To make quite sure of the diagnosis, and to place the bone in the best possible position for recovery, chloroform was then administered, and it became evident to all who examined the case when the pain of manipulation was overcome by the ansesthetic, that the case could not be other than a separation of the epiph ysis. After reduction by pressure and extension, a well-padded splint was applied from the wrist to the end of the thumb on its dorsal aspect. The case was afterwards watched by Mr. Targett, and I understood from him that a complete recovery without deformity took place in about three weeks.
doi:10.1016/s0140-6736(02)28678-x fatcat:wqf73zgolfegdatgsopac7b7aq