A Backward Dislocation Of The Thumb (Hey's) at the metacarpo-phalangeal joint is not uncommon, being caused generally by forcible hyperextension, and presents considerable difficulty in reduction. This difficulty has been variously attributed to the backward displacement of the plate of fibro-cartilage forming the palmar ligament, which has just been mentioned as causing difficulty in the fingers, and which carries with it the short muscles attached to the sesamoid bones ; to entanglement of the long flexor tendon ; locking of the metacarpal bone between the lateral ligaments, or heads of the flexor brevis, etc. To reduce the dislocation it is advised to extend the phalanx till at right angles to the metacarpal bone, and while in this position, to carry the base of the phalanx over the metacarpal head, and then to flex the phalanx suddenly. Subcutaneous section of the palmar ligament from the extensor aspect is said to permit of easy reduction. Amputation of the thumb with its metacarpal bone is best done through a vertical incision over the subcutaneous radial border of the metacarpal bone. The metacarpal bone is excised subperiosteally, and the finger removed by an elliptical incision at the lower end of the vertical one. Amputation of the fingers is frequently performed at the metacarpo-phalangeal or interphalangeal joints. In the former position a racket incision is generally best, taking care to keep the racket distal to the web of the finger, while the handle of the racket extends upon the dorsal surface over the joint. In the case of the index and little fingers the handle of the racket should be kept toward the centre of the hand, so that the scar will not present on the pressure surface. Further, it is not wise to remove the head of the underlying metacarpal bone, as it weakens the hand greatly. At the interphalangeal joints the knife is entered dorsally just distal to the flexed knuckle ; then, having opened the joint, the edge is directed distally, and a long palmar flap is cut from the anterior surface of the phalanx. The bases of the distal phalanges should be saved where possible, as they carry the insertions of the flexor profundus tendons. If the lower half of the middle phalanx can be preserved, the insertions of the flexor sublimis to it would be saved. Where tendons are cut within their sheaths, as at the first interphalangeal joint, they generally retract markedly, leaving the phalanx without power, and the gaping sheath also makes spread of sepsis probable It is well, therefore, to stitch the end of the divided tendon to the sheath, and close the mouths of the latter. Removal of fingers should be done sparingly, particularly in the case of the thumb, index, and little fingers.