Talk:Paper - Familial abnormalities of the middle phalanges of each hand (1923)

FAMILIAL ABNORMALITIES OF THE MIDDLE PHALANGES OF EACH HAND

By R. C. D’ARCY HANN, B.A. (Canras.)

"Tue condition about to be described seems extremely rare, a search of what literature is available revealing no parallel case.

It is to be regretted that a more detailed account cannot be given owing to difficulties made by the patient: for example, an examination of the feet was refused and of the family history it was only certain that of seven or eight members similarly deformed the mother, her brother, and sister were included. The man examined had no brothers and only one sister and she was unaffected.

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The mother and son were seen and the condition on examination seemed exactly similar. The radiograph and description is that of the son aged 19. The hands were not greatly ill-shaped though they had an appearance of squatness; the first impression on inspection being that all the first interphalangeal joints were missing. The movement at the terminal joint was very 268 R. C. D’Arcy Hann

free and so comparatively little disability of the hand resulted. On examination of the radiograph the striking feature is the restriction of the abnormality to the second phalanges, all of which are involved.

The deformity is symmetrical but for the fact that in the ring finger of the left hand the segment representing the second phalanx has become united to the proximal phalanx. The bone representing the second phalanx varies from a small fragment in each little finger (strangely displaced laterally) to well formed segments, with normal joints above and below in the ring and index fingers, whilst in the middle finger and right ring finger the segments have actually fused. The line of union is obvious and there has been no suggestion of a joint.

We may also note a tendency to a displacement of the terminal phalanges towards the middle line of the hand.

There seems no doubt that the proximal and terminal phalanges are normal and the interpolated bones are not abnormal epiphyses.

An interesting comparable case was published by Dr Drinkwater (in this journal)! of a family showing abnormal segmentation of the index and middle fingers. The fault there was entirely confined to fingers whereas here only one phalanx is concerned.

Under the belief that a hand deformity existed throughout many generations of an old family of the British Peerage the writer, in answer to a letter he had sent, received an account from a well-known member of the family.

She writes: “Some of my great uncles had deformed joints in their fingers, the first joint being absent, and two of them had only one joint in each thumb. My own aunts and uncles all had perfect joints, but I personally have only one joint in each thumb.”

The writer is indebted to Dr Scargill for the excellent radiograph.

1 Journ. Anat. and Phys. vol. L. 1916.