he commonest displacement is backward. The thumb seems to
suffer oftener than the other digits. These injuries, however, are so
rare, and the deformity is so characteristic, that a detailed
description is unnecessary.

#Sprain of the wrist# is a common injury, and results from a fall on
the hand, a twist of the wrist, or from the back-firing of a
motor-crank dorsiflexing the hand. The marked swelling which rapidly
ensues may render it difficult to distinguish a sprain from the other
injuries that are liable to result from similar causes--Colles'
fracture, separation of the lower radial epiphysis, dislocation of the
wrist, and fractures and dislocations of the carpal bones.

In a sprain the normal relations of the styloid processes and other
bony points about the wrist are unaltered, and there is no radial
deviation of the hand, as in Colles' fracture. The most marked
swelling is over the line of the articulation on the anterior and
posterior aspects of the joint. There is usually some effusion into
the sheaths of the tendons passing over the joint, and in some cases
on moving the fingers a peculiar creaking, which may simulate
crepitus, can be elicited. There is marked tenderness on making
pressure over the line of the joint, as well as over one or other of
the collateral ligaments, depending upon which ligament has been
over-stretched or torn. Movements that tend to put the damaged
ligaments on the stretch also cause pain. It has to be borne in mind,
however, that in many cases of Colles' fracture there is extreme
tenderness on pressing over the ulnar styloid and medial ulno-carpal
ligament, as these structures are frequently injured as well as the
radius, but the point of maximum pain and tenderness is over the seat
of fracture of the radius. In all doubtful cases the X-rays should be
employed to establish the diagnosis.

The _treatment_ consists in the immediate employment of massage and
movement, supplemented by alternate hot and cold douches, on the same
lines as in sprains of other joints.

INJURIES OF THE FINGERS

#Fracture.#--_Fractures of the metacarpals of the fingers_ are
comparatively common. When they result from direct violence, such as
a crush between two heavy objects, they are often multiple and
compound. Indirect violence, acting in the long axis of the bone and
increasing its natural curve, such as a blow on the knuckle in
striking with the closed fist, usually produces an oblique fracture
ab