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Updated: June 21, 2025
Subcutaneous Whitlow. In this variety the infection manifests itself as a cellulitis of the pulp of the finger (Fig. 9, c), which sometimes spreads towards the palm of the hand. The finger becomes red, swollen, and tense; there is severe throbbing pain, which is usually worst at night and prevents sleep, and the part is extremely tender on pressure. When the palm is invaded there may be marked œdema of the back of the hand, the dense integument of the palm preventing the swelling from appearing on the front. The pus may be under such tension that fluctuation cannot be detected. The patient is usually able to flex the finger to a certain extent without increasing the pain a point which indicates that the tendon sheaths have not been invaded. The suppurative process may, however, spread to the tendon sheaths, or even to the bone. Sometimes the excessive tension and virulent toxins induce actual gangrene of the distal part, or even of the whole finger. There is considerable constitutional disturbance, the temperature often reaching 101° or 102°
The femur is more like that of the Paloeotheria than that of the horse, and has only a small depression above its outer condyle in the place of the great fossa which is so obvious in the Equidoe. The fibula is distinct, but very slender, and its distal end is ankylosed with the tibia. There are three toes on the hind foot having similar proportions to those on the fore foot.
The front toes are still three, but the outer ones are more slender than in Anchitherium, and their hoofs smaller in proportion to that of the middle toe: they are, in fact, reduced to mere dew-claws, and do not touch the ground. In the leg, the distal end of the fibula is so completely united with the tibia that it appears to be a mere process of the latter bone, as in the Horses.
The other side of the rod bears a larger number of notches, of which the most distal marks the greatest length of the mid-day shadow, the next one the length of the mid-day shadow three days after it has begun to shorten, the next the length of the shadow after three more days' shortening, and so on.
The available operative measures are proximal ligation of the innominate, and distal ligation. In some cases it has been found necessary to combine distal ligation with amputation at the shoulder-joint, to prevent the collateral circulation maintaining the flow through the aneurysm. Matas' operation has been successfully performed by Hogarth Pringle.
Open navicular joint does not occur, as a rule, except by way of the solar surface of the foot, and the introduction of active and virulent contagium is certain to happen; consequently, an acute synovitis quickly resulting in an intensely septic and progressively destructive arthritis soon follows in perforation of the capsule of the distal interphalangeal articulation. Etiology and Occurrence.
Three types of lesion result from indirect violence: the whole plexus; the upper-arm type; and the lower-arm type. When the whole plexus is involved, sensibility is lost over the entire forearm and hand and over the lateral surface of the arm in its distal two-thirds.
The ligature may be applied on the cardiac side of the aneurysm proximal ligation, or to the artery beyond distal ligation. Proximal Ligation.
a, Extensor carpi radialis; g, brachialis; g', anterior superficial pectoral; c, common digital extensor; e, ulnaris lateralis. The fascia and the ulnar head of the flexor carpi ulnaris have been removed. 1, Distal end of humerus; 2, median vessels and nerve. Motion is that of flexion and extension; slight rotation is possible when the position is that of flexion.
At the proximal end there forms a bulbous swelling, which becomes adherent to the scar tissue. It consists of branching axis cylinders running in all directions, these having failed to reach the distal end because of the extent of the gap.
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