This is in some respects the most interesting of the remote preventable results of 'sprains' so-called. These deformities are met with most commonly in the fingers, but are also seen in the knee, in the form of genu valgum principally; in the hip, and at the wrist and ankle. In adults they are virtually always the result of undetected fracture; in growing people they may arise from injuries to the epiphyses, but even in these subjects undetected fracture is the commonest cause.1 Sprain of an epiphysis may cause arrest of development or irregular growth, the best example of the latter condition being certain cases of genu valgum.

1 In three cases of 'motor sprain' in young subjects which came under notice the x-rays showed separation of the lower epiphysis of the radius.

Fig. 12 Diagram illustrating the mechanism of deformity following upon undetect fracture of base of phalanx of finger.

Fig. 12 is a diagram showing the mechanism of a characteristic case of deformity of a finger following 'sprain.' There has been an oblique fracture of the base of one of the phalanges; the fracture having been undetected, no means were taken to secure adhesion of the separated part during the use of massage, etc. The result is that the fragment has glided upwards in such a way as to cause the distal part of the finger to fall over in an angular deformity.

Plate VI a shows a skiagram of a case of a very exaggerated kind in which the same distortion is in course of occurrence. Such deformities of the fingers after sprains are not unfrequently attributed to osteo-arthritis; genu valgum and genu varum may arise in the same way. The following is a typical example.

A young man, twenty-two years old, strong and healthy, consulted me on account of genu valgum of an exaggerated kind, which was said to have come on rather rapidly during the convalescence from a severe sprain of the knee. An x-ray photograph clearly showed that the external condyle had been detached by an oblique fracture and had glided upwards, so that when attempts at walking were made the leg necessarily bent outwards from the knee.

A few years ago 'sprains' of the hip were spoken of as being sometimes followed by shortening of the limb from a mysterious change in the bone, which was thought to bring about an alteration in the angle at which the neck of the femur left the shaft. The x-rays have abundantly shown that the common cause of this deformity is undetected fracture of the neck of the thigh-bone, and in a few cases perhaps injury to the epiphyses in growing subjects.

It is a singular thing that there is even now a disinclination upon the part of some people to utilise the x-rays in cases of sprain. Recently an instance has come to my knowledge in which a practitioner of large experience and repute advised against the use of the x-rays on the grounds that they would merely corroborate his diagnosis in a case of 'sprain' of one of the larger joints. Symptoms having subsequently arisen which were hardly consistent with a mere sprain, however severe, the x-rays were employed, upon the recommendation of another authority, with the result that a very manifest fracture was revealed.

An attitude of this kind towards a means of diagnosis which in competent hands can set at rest once and for all any question as to fracture with absolute certainty passes the comprehension of a person of only ordinary intelligence.