Booksby Adriana Locke
My Amazon Store
Brewer Family Series
The Proposal|The Arrangement
Carmichael Family Series
Flirt|Fling|Fluke |Flaunt|Flame
Landry Family Series
Sway|Swing|Switch|Swear|Swink|Sweet
Landry Family Security Series
Pulse
Gibson Boys Series
Crank|Craft|Cross |Crave |Crazy
The Mason Family Series
Restraint|The RelationshipPact|Reputation|Reckless |Relentless |Resolution
The Marshall Family Series
More ThanICould|This MuchIs True
The Exception Series
The Exception|The Perception
Dogwood Lane Series
Tumble |Tangle |Trouble
Standalone Novels
Sacrifice |WhereverItLeads |Writteninthe Scars |LuckyNumberEleven|Like YouLove Me |The SweetSpot|NothingButItAll|
Cherry Falls Novellas
608AlphaAvenue |907ForKeeps Way Foracompletereadingorderandmoreinformation,visitwwwadrianalockecom
Synopsis
When celebrity Laina Kelley bolted from her small hometown church on her wedding day, she ran to the first place that came to mind to the home of the local farrier, a gorgeous playboy who just so happens to be her first love and biggest frenemy.
USA Today bestselling author Adriana Locke delivers a new “sweet and spicy!” standalone romance about a runawaybridewhofindsherselfinthehorsebarn,andarms,ofherdeliciouslyhandsomefrenemy whojustsohappens tobeherfirstlove.
Thisisn’tyouraverageromance.Itbeginswithmeinaweddingdress,justnotatanaltar…
Inever expected to be a runawaybride. Ialso never thoughtI’d end up onmyex’s doorstep to flee frommywedding. However,I’mhere,andit’seasytofindthekeyinanoldbootbythedoorandletmyselfin.It’snotbreakingandenteringifI haveakey,right?
It’ssafetosaythatLukeMarshalldidn’texpecttofindmeonhiscouchinmyweddingdress Hehasnochoicebuttolisten tomypanic-inducedpleaforrefuge.It’sonlyamatteroftimebeforethetabloidsgetwindofmydisappearingact,andthen? MylifeasIknowitisover
LuketakespityonmeandsaysIcanstay ononecondition
Ican’tsingformysupper.Ihavetoearnit. In the barn.I’llbeuptomyelbowsinhorsemanure.Andbecausethere’sonly onebed,Igetthecouch.
Thisworks…intheory.Butwhensparksstartflying,I’mofferedapermanentplacetostay inhisarmsforever.I’llhave todecidebetweenmylifeasapopstarandasecondchancewithmyfirstlove.
Chapter One
Laina
“Whatdoyoumeanyou’reontherun?”
Stephanie’s questionis valid, as is her curious but mostlynonchalant wayof askingit. After all, it’s me we’re talking about.Butsheshould’vebeenmoreprepared.
“DoIreallyneedtobreakitdownforyou darn it!”Iprymyheeloutofaslitintheasphalt.“Besides,whenyourbest friendcallsandsaysshe’sontherunandneedsyourhelp,theonlyquestionyoushouldaskis whose car are we taking?”
“You’re so funny”
Iglance tomyright,thentomyleft.Atrail ofsweattrickles betweenmyshoulder blades.Aside fromtwomeninfitted suitsandsunglassesfromthesecurityteam,I’mintheclear
“There’snothingfunnyaboutthis,”Isay,dartingacrosstheparkinglotasgracefullyaspossibledespitethelayersoftulle.
“ThelasttimeIsaw you whichwasapproximatelyfifteenminutesago,giveor take youwereinyour weddingdress, lookingstunning,Imightadd,waitingforyourfathertoshowuptowalkyoudowntheaisle”
Fifteen minutes? Man, I work quick.
ThecrowdroarsfromtheothersideofthesafetybarrierLandrySecurityerectedthreedaysagotokeepfansandpaparazzi mostlypaparazzi awayfromthechurch.Brickfieldhasbeenteemingallweekwithspectatorseagertoseewhatthemedia hasdeemedtheweddingofthecentury Formerclassmateswereinterviewed Mykindergartenteacherwasonthefrontpageof Exposé magazine this week. Alleged encounters withthe “meninmylife” since Ibecame famous have beendissected and analyzedtodeath.Ifonlyhalfofwhatwasprintedwerereal,mylifewouldbefarmoreentertaining.
Iwould’vefeltbadforSheriffJonesinhisplighttoorganizearesponsetothislevelofanarchyinatownoffivethousand peopleifhehadn’tusedmyweddingasthelaunchofhisre-electioncampaign.
“What’sgoingon,Laina?Areyoujokingaround,orissomethingreallythematter?”
“ConsideringI’mcurrentlyhidingbetweentwoshedsandhopingnooneisflyingdronesoverhead,I’dsaysomethingisthe matter”
“Whyareyoubetweentwosheds?”
Ispitapieceofmyveiloutofmyface.“Ican’tmarryhim,Steph.”
Mybest friend goes silent I imagine her face mouthagape, brows arched higher thanthe laminationtreatment should allow,andawrinkledforeheaddefyingherBotox.SheworethesameexpressionwhenItoldherIwasmarryingHollywood heartthrobTomWaverlyayearago completeanduttershock
“Ishould’ve listened to you,” Isay, takinga steadyingbreath. “Inever should’ve accepted his proposal atall, letalone planaweddingandinviteonehundredfiftypeopletothechurchandanother twohundredtoareceptionthatcostmorethan …”Dreadrollsthroughthepitofmystomach.“Let’snotevengothere.”
“Okay.”Hervoiceiscoolandtempered.“Whatdoyouneed?”
“Ironicallyenough,Ineedyoutoaskwhosecarwe’retakingbecausetheansweris I don’t know Ididn’tthinkthisthrough Iexcusedmyselffromtheroom,shutthedoor,andleft.”
“We’rethrowingaplottwistatthelastsecond,butthat’sokay Ithinkquickonmyfeet,sodon’tpanic”
“Strangely, I’m not. I don’t know whether that’s because I’m blocking out the ramifications of this wholly impulsive decisionor ifthisismygut’swayofthankingmefor followingit.”Ipeer aroundthesideofoneofthesheds,nearlygetting bustedbythebestman.“I’lltakeiteitherway.”
“We’regoingwiththelatter.Now,whereareyou,exactly?”
“Behindthechurch Therearetwoshedswithahedgerowbehindthem I’mbetweenthebuildings”
The crowd roars once again. Butinstead ofthe ordinaryscreams and whistles, theybeginto singthe chorus ofthe most
popularsongoncountryradio
“GuessSam’shere,”Isay,sighing.
“Don’tworryaboutwhoishere Let’sworryaboutgettingyououtofhere” “Thereinliesmyproblem.”Inibblethelipstainthattookmesixmonthstopickout.“Peopleareeverywhere.Ican’tjust walkoutthegateandontothestreet Igetrecognizedinawig,hat,andsunglasses,letaloneafreakingweddingdress” Myheartpoundsastheweightofmyactionssinksin.
Tomwillbehumiliated Thebiggestmoviestarintheworldwillbeleftstandingatthealtarbythepopstartheworldis quicktolabel frivolous.Myparents’furywillbeimmeasurable. How dare I be so careless with my image when so much of their success is riding on it?MyPRteamwillbeinundatedwithcallsandemails.Myassistant must stayoutofsightuntilthis coolsdown,andmyfanswill jumptoconclusionsandassumetheworstaboutme About Tom Critics will claimthis was a publicitystuntwhenit’snothingmorethanawomantryingtosalvageherfutureamidafewbadchoices.
“MaybeIshouldjustgothroughwithit,”Isay,achillpricklingmyskin “Theramificationsofthis ” “It’stenyearsfromnow,andyou’reonabeach.” “Canwetalkaboutvacationslater?”
“Andyoulooktoyourleft,andthere’sTom,”shesays.“Howdoyoufeel?” Sick.
Uneasiness stirs inmystomach Instead ofimaginingTomgazingadoringlybackatme, Iinstantlynotice the angrylines aroundhiseyes.Hisvoicesweepsthroughmyhead.
“There are calories in those drinks, you know” “We’re going to have to talk about you easing up on the music thing when I start filming my next project in the winter.” “Can’t you choose more conservative costumes? You’re a grown woman, for fuck’s sake I don’t want my wife out there looking like a whore.”
Igrapplewithhowtophrasethat,butStephaniesavesmethetrouble.
“Nowimaginethatyoulooktotheleft,andhe’sgone,”shesays “Howdoyoufeelnow?” Peaceful.
Relief eases the tension in my shoulders and quells the knot in my stomach I don’t try to answer her this time; it’s unnecessary.
“The ramifications of going back in that church and marrying Tomare far worse than the inconvenience it will cause everyoneelseifyoudon’t,”shesays.“I’llsupportyoueitherway.Butyourfatherwasjustinherelookingforyou,andwhileI canstallhimforalittlebit,youneedtodecide.”
Ashiver runs the lengthof myspine Aflushstings mycheeks Myheart somehow lodges inmythroat, and eachbeat remindsmeofthesecondstickingby.
Ican’tdoit Ican’treturntothatchurchandwalkoutasMrs TomWaverly Thethoughtmakesmewanttohurl “Themediawillhaveaheydaywiththis,”Isay,mybackpressedagainsttheshed.“Icanseetheheadlinesalready.” “Ignoreallofthat.You’regoingtowakeupmarriedornot.What’sitgoingtobe?”
Mybreathquickens “I’mnot” “You’resure.”
“Yes”
Adoorclosesinthebackground.“Okay,thisistheplan.”
Asmiletugsatmylips
“Icouldborrowacarandpickyouup,butsomeonehastobeheretoheadoffyourparentsandTomuntilyou’vemadeyour exit,”shesays.“Thesecurityteamisourbestbet,Ithink.They’reunderanNDA,andyouhiredthem,right?NotTom?” “Yeah,Idid”
“Okay.Letmefindoneofthemandgetthemtopickyouup.Youstayput.I’mgoingtobideyousometimewithyourfather. WhoshouldIcontactonyourteam?”
“Myagent.AnjelicaGraceatMasonMusic,”Isay.“TellherI’llcallherassoonasIcan.” “I’monit Doyouneedmetodoanythingelse?”
Itakealongbreath.“Don’tbetheonetotellTom.Letsomeoneelsedoit.” “Gotit.Now,holdtight.I’llhaveacarthereasfastasIcan.” “Iloveyou,Steph” “Loveyoumore.”
“Oh!Andmyengagementringisinyourpurse” “Gotit.”
Thecallends.Idropmyarmtothesideandavoidlookingatthephonescreen.Peopleareprobablyalreadysendingtexts andlookingforme.Ican’tdealwithit.Notyet.
I’m really doing this. I’m really running away from my wedding.
MyheadbeginstospinwithalltheimmediatedecisionsImustmake.Ihavetogetmythingsfromthehotelbeforeit’staken over bythe weddingpartyagain. Can anyone track my phone? How will I get out of here without alerting the media and bystanders?
Is that even possible?
BeforeIcangotoofardowntherabbithole,ablackSUVrollsupperilouslyclosetotheshed Thewindowsarejetblack, makingitimpossibletoseeinside.Nervesripplelowinmystomachasamaninoneofthosetailoredsuitsslipsalongsidethe vehicle
HetakeshisglassesoffsoIcanseehisgrayeyes. Troy Castelli. Thank God. “Ms.Kelley,Iheardyou’dlikearide.”
Achuckleescapesme “Ican’tbelieveI’mdoingthis,Troy” “I’mhappytotakeyouwhereveryouwant.”
“Ijustwanttogetoutofherewithoutmypicturebeingsplashedonsocialmedia Canyoupullthatoff?”
Heopensthebackdoor.“Absolutely.”Heturnstooffermeahandandthensees,forwhatseemslikethefirsttime,thetulle thatmustalsogointheSUV“Howdowegetallof that inthere?”
“It’stulle.”IbunchasmuchofthefabricinthefrontasIcan.“Ihateit.”
“Thenwhydidyouchooseit?”
The questionmakes me pause Why did I choose tulle over lace? Surf-n-turf over chicken strips and sliders for the reception? The diet drink over the full sugar soda at the rehearsal dinner? “Troy,itseemsI’mabitofapushover”
“Nooffense,ma’am,butalotofpeopleinsidethechurchwouldprobablydisagreewithyou.” Igrin,standingalittletaller.“You’reright.Nowshovethisgodforsakendressinthecar,andlet’sgetoutofhere.”
WithalittleworkandalotofpushingwhitefabricintoeveryvacantspaceinthebackoftheSUV,wemakeitwork.Troy isinthedriver’sseatintheblinkofaneye.
“We’llgooutthebackserviceentrance,”hesays,holdingmygazeintherearview mirror “Youcanbreathe,Ms Kelley It’sgoingtobeallright.”
Iexhale,thesoundtakingupalltheroomthetulleisn’t I hope you ’ re right
Myheartpoundsaswerolltothebackofthechurch.Troymakesahandsignaltoapoliceofficeratthemakeshiftgate,and it’simmediatelymoved.
ThecrowdhasnearlytripledsinceIarrivedtwohoursago.Thestreetshavebeenclosed,andpeoplehavefilledtheblock surrounding Mt. Calvary Church. Lawns of the nearby houses are littered with bodies. Television crews are set up on sidewalkswithvansandmicrophones
It’samess.
Andabouttogetmessier
Iglanceattheclockonthedash.Theceremonyissettostartintwominutes.Isqueezemyeyesclosedandtrytoignorethe fireblazinginmystomach.
“Ms Kelly?”
Iopenmyeyes.“Yes?”
“Whereareweheaded?”
Oh. Right.
Good freaking question
Adrenalineflowsthroughmyveins,andmypalmsstarttosweat. Where are we headed?
Thehotelisout.Thebridalpartywillinevitablyreturntotheirroomstogathertheirthings.Nottomention,there’snoway I could get into the hotel discreetly and make it to my room My parents’house is a definite no I’d be emotionally and physically burned at the stake. I could ask Troy to drive me to the airport, but that’s an hour and a half away, and no reservationshavebeenmade Mypassportisatthehotel And what do I do with all this damn tulle?
Breathe, Laina.
TheremustbesomewhereIcango IsortthrougheverypersonIstill know inBrickfield whichisn’tmany.I’ve lostcontactwithnearlyall myoldfriends since Ileftsixyears ago. Ican’ttrustanyone to hide me until Ifigure this disaster out, anyway. Ican’tevengeta roomin PeachwoodFallsbecausesomeonewouldwindupseeingme,andI’dgettrappedwithnowayout
“Howabout…”BeforeIcanaskhimtofindabackroadtokillsometimewhileIthink,theanswerpopsinmyhead. Itissafe Probably
Imaynotexactlybewelcome,butIwon’tbeforcedtoleave. I don’t think. Therewilldefinitelybenothingtoeat,thebeddingwillneedtobewashed,butI’llbeabletoletmyselfinside.
Mylipscurlslowlyintoasmile.And,forthefirsttimetoday,Idon’tfeellikethesunissettingonmysoul. “SeethatsignforPeachwoodFalls?”Iask.“Headthere.”
Chapter Two
Laina
Theasphalt,bustedwithpotholes butasphaltall thesame,turns intogravel Troyslows theSUVas its tires crunch acrosstherocks.
Thefieldontherightsideoftheroadhasapathleadingtoasmallerfieldintherear.It’sontopofahill,surroundedby trees,andwastoomuchofapainintheasstofarm,accordingtotheoldfarmerwhousedtotendtotheland.MyfriendsandI spentmanyweekendnightsbacktherelisteningtomusic,buildingbonfiresthatalmostgotawayfromus,anddrinkingcheap wineandevencheaperbeerliketheadultsweweren’t
If only we knew how overrated adulthood really was … Ontheleftisacornfield Asmallbrownhomeistuckedofftheroad Thefamilywholivedthereweresosweet Thefather worked for the DepartmentofNatural Resources and adopted a fawnthatwas leftbehind whenits mother was shotduring huntingseason.Thelittlethingwouldeatanappleoutofyourhand.
Iwonderwhathappenedtoit
“Justdownthishillandaroundthecurve,”Isay,shivering. Why is it so chilly in here? “Thedrivewayishardtoseebuton theright”
Troynods.“ShouldIwaitwithyououtsidethehouse,orwouldyouratherIwaitdownbytheroad?”
“Withallduerespect,Iwouldratheryoureturntothechurch”
Afrowndarkenshisface.“I’msureyouunderstandIcan’tdothat,ma’am.”
Iholdhisgazeintherearview mirror,anger frombeingtoldwhatIcanandcan’tdoinmyowndamnlifeboilinginside me Butthat’snotTroy’sfault He’sdoingwhathe’spaidtodo Andhe’sbeingpaidbyme.
“Look, I appreciate your concernand understand the challenge of returningwithout me,” I say “But I need a minute to myself,and I really neednoonetoknowwhereIamforawhile.”
Hewatchesmewarily
“Trustme.Idon’twanttogetwhackedbyacrazedstalkermorethanyoudon’twantmetobe,okay?”
“Iwillhavetotellmyboss,Ms.Kelley.”
Great
MyresponseisdelayedastheSUVslowsattheendofasmallbridgecrossingacreek.Thedrivewayisnexttoamailbox that’sseenbetterdays Weslipbetweenthemailboxandguardrailandfollowthebendaroundahedgeoftrees Andthereitis.
Myhearthammersagainstmyribcageastheyellowhousewithbrowntrimcomesintoview,itsattachedgarageandlarge barnbehind it. The lake below reflects the clear blue sky, and if I weren’t runningonadrenaline and eagerness to extract myselffromthissituation,Iwouldappreciatethebeautyandstillnessofthemoment.
Thevehiclepullstothetopofthedrivewayandstops Istare atthe door, wonderingifhe’s home. What will he say? What will he do? Despite the chance thatLuke Marshall won’tbepleasedtoseeme,myanxietyisthelowestit’sbeenallday Myshouldersslumpagainsttheseat.
“Thisisit?”Troy’ssunglassesaregone,andhe’ssurveyingthelandscapeforthreats.“Wantmetowalktheperimeteror, betteryet,cleartheinside?”
Isitup.“Promisemeyouwon’ttellTomormyparents,”Isay,holdingontothebackoftheseat.“IfyouhavetotellFord Landry,thenfine Butlethimknowthatifhesharesmylocationwithanyone I’llfireyouall” Hiseyesblazewithfrustration,butheheedsmyrequest.
“Yes,Ms.Kelley.”
Iopenthedoorhandle,butnothinghappens.Troytriggerstheunlockfeatureandhopsoutofthedriver’sseat.Whenhe’s aroundtomysideoftheSUV,I’mgatheringthetulle
“Icanstayoutofsight,” he says, clearlystrugglingwithleavingme ona randomdoorstep. “Iassure youthatyouwon’t knowI’mhere”
Mybarefeethitthesharprocksontheground,andIwince.“Nope.Igotthis.”
“I’llwaituntilyou’reinside”
“Nope.”Isquaremyshoulderstohis.“I got this. ” Hehesitates.“Callmeifyouneedme.Doyouhavemynumber?”
“Yes And,Troy?Thankyou”
HemumblessomethingIcan’thear,closesmydoor,andthengoestotheotherside.Iquicklycrackitopen,turnmyphone off,tossitontothefloorboard,andclosethedooragain Mymanagement’sinsistencethatImemorizemymostimportantphone numbersisfinallycominginhandy.
Ashedrivesoff,roundingtheturnandeffectivelygoingoutofsight,Iblowoutthedeepest,heaviestbreathofmylife I face the house that holds so many memories. The walkout basement that Luke and I used when we didn’t want his grandfather, PoppyMarshall, to know we were there. The birdbathnext to the house has a permanent crackdownthe side because Luke hititwithhis truckone winter while slidingonthe ice Iglance atthe frontporch And the old pair ofboots behindtheporchswing theonewiththehousekey.
“Ouch,”Ihiss,steppinglightlyonthegraveltowardthestairs
Myminddriftsaway,carryingmebacktothesituationatthechurch.HowisStephaniehandlingthedrama?Ienvisionthe statementTomiscomposingforthepress. He’s undoubtedly feeding me to the wolves.Ittakeslittleimaginationtopicturemy parents’displeasure. Did they outright take Tom’s side, or do they wonder, if even for a moment, what my side of the story might be?
Tearsfloodmyeyes,foggingmysight
If I had stayed, I’d be a married woman right now. MyhandsshakeasifI’vejustavoidedbeingmugged Thethoughtofcuttingitsoclose almostbeingMrs.TomWaverly makesmenauseous.EventhoughI’llundoubtedlybe onthereceivingendofnastyvitriolinthecomingdays,it’sasmallpricetopayforavoidingamarriagethatwould’veended indivorce.Tommaynotunderstandit,butIdidusbothafavor.
I grab the rail and pull the tulle behind me up the stairs. Poppy’s standingashtrayfromdecades ago is still next to the swing Thesightofitsurroundedbytheridiculouswhitefabricmakesmegrin Ipressthedoorbellandwait.There’snomovementinsidethehouse.Ipressitagain.
MyheartpoundsasIdipmyhandintotherightboot
“Sopredictable,Luke,”Isay,pullingoutthesparekey.Istickitinthelock,andthedoorswingsopenasifwaitingforme. Thethoughtmakesmesmile.
Thehardwoodiswarmonmybarefeet Anearthinessuniquetothisplace mudmixedwithtobaccoandkissedbythesun greetsmelikeanoldfriend.IshutthedoorbehindmeandventureintoLuke’shouse.
Abigger televisionhangs onthe wall The refrigerator has beenreplaced Afew more pictures have beenadded to the collectionoffamilyphotosontheunuseddiningroomtable.NotmuchhaschangedinthesixyearssinceIwashere.Yet…
EverymoveImakeislikeapindroppingtothefloor It’sasifthehouseisholdingitsbreathlikeme Somehow,itfeels likeIjustcameinafterashiftatTheScooptodohomeworkwithLuke.
MydressswishesagainstthefloorasIcrossthekitchentoinspectthephotographs.
Somanyframedmemorieshavebeenhereforyears picturesofPoppyandLuke’sgrandmaandLuke’sparents Thereare photosofLukeandhissiblings.Myfavoriteoneisinthecenterofthetable,andIpickitup.
Luke gives the camera the cheesiestgrin To his rightare his oldestbrothers, Chase and Mallet Onhis leftis his little sister,Kate.Crouchedinfrontofthem,asifhemightattackthepersontakingtheshot,istheirbrotherGavin. God, I love these people
It’shardtobreatheasIgazeatthefacesIhaven’tseeninalongtime facesofsomeofthebest,mosthardworking,saltof-the-earthpeopleI’veevermet.Theylovedmeliketheirown.Ilovedthemrightback.Untileverythingfellapart…
Iwipeawaythetearsrollingdownmycheeksandsetthepicturebackinitsplace
“Ishouldn’tbehere,”Iwhisper,lookingaroundthehouse.“WhatamIdoing?”
Panicsurges,usingthecrackinmywillpowertomakeitselfknown MystomachclencheslikeImightpuke Fight-or-flight instincts kick in. My brain screams at my legs to move, to walk to leave before I make a mess of things, but my heart whispers no.
There’snowhereelsetogo,anyway.
I’mroyallyscrewed.
Isitonthebrownplaidcouch.Thespringsbitethroughallthefabricattachedtomybuttandbiteintomybones.AtleastI canfeelit.AtleastI’mnotthat numb.
Gravel poppingunder theweightofavehicleringsthroughthesilence Iboltupright,unsurewhether torunouttheback doororsitstillandtakewhatevercomesmyway.Forthebriefestofseconds,IregretaskingTroytoleave.
Adoorshuts Bootsclimbthestairs Thehandleturns,thehingescreaking Igrabtheedgeofthecouch,holdingmybreathandwaitingformyeyestomeetLukeMarshall’s.
Whenheenters,hisheadisdown Heshutsthedoor withhisfoot Withhisphoneinhishand,heliftshisfaceandstops mid-step.
Thephoneclatterstothefloor.
Igaspasourgazescollide,andtheworldoutsidethisroomceasestoexist Thecollisiontakesmybreathasheatsizzles throughmybody,snakingdownmyspineinaslow,torturouscurl.
Istruggletocatchmybreathamidthebutterfliessweepingthroughmystomach
Oh, my …
LukeMarshallisallgrownup
Age has done fine things to this man, fillinghimoutinall the right places broad shoulders and a barrel chest. Abelt showsoffhistrimwaist.Angledjaw. Long lashes.Hewearsaday’sscruffthatmakesmeshiver. Noamountofsocialmediastalkingcould’vepreparedmeforthismoment Hetiltshisheadinsurprise,theninconfusion.
Asardonicsmilepartshiskissablelips “Whatinthehellareyoudoinghere?”
Chapter Three
Laina
Hisvoice playfulandrichwithahintofmischief sweepsacrosstheroom It’sasifafuseisextinguished,andmy worldhasstoppedcareeningtowardtheedgeofacliff.Ibreathefreelyforthefirsttimeindays.
“Hey,Luke,”Isay.
Hescratchesthetopofhishead,thenrunshispalmdownthesideofhischeek.Hismouthopens,andhetakesabreathlike he’sgoingtospeak.Instead,hechuckles.
Reliefrollsoffmeinwaves
“Aren’tyousupposedtobegettingmarriedtoday?”heasks,ateasingquirkatthecornerofhismouth.
“I’mnotsurewhatwouldgiveyouthatimpression”
Heliftsabrow,keepinganeyeonmewhilehepickshisphoneoffthefloor.“Idon’tknow.Couldbetheweddingdress. Mightbeyourpicturesandtheword wedding splashedalloverthenews.Thenagain,itcouldbealltheassholesinfancysuits sittingaround The WetWhistle talkingaboutthe economyand notevenhavingthe courtesyto laughatTucker’s jokes” He tossesthephoneonthetablebeneaththetelevision.“Youchoose.”
“I’llgowiththeassholesinfancysuits ButI didn’tinvitethem Theyareherebyinvitationfromthegroom” “Speakingofthegroom,whyaren’tyouwithhimagain?”
Myinsidesstillaswewatcheachother
Onceuponatime,Icouldpeerintothosebeautifulgreeneyesandknowexactlywhathewasthinking.AndIwouldn’tdare lookathimifIdidn’twanthimto read me like a book. Buthis gaze now holds stories we don’tshare, experiences Idon’t understand,andwoundsIdidn’theal Thedifferencecutsmetothequick Justasmyheartraces,heflashesmehiscrookedsmile.
Isigh,fightingasmileofmyown “Ikindoflefthimatthealtar” “Ballsywaytostartamarriage.”
“Yeah,itwouldbeifwewerestartingone”
Heleansagainstthewall,andafaintsmirkkisseshislips.“Ihavesomanyquestions.” “Ibetyoudo.”
Heholdsmygazeforamomentandthenstandstall “Let’sstartwiththemostimportantone” Ibracemyself,expectinghimtoaskwhyIleftmywedding. “Isanyonecomingherelookingforyou?”heasks What?“Why?Didyouseesomeone?”
Asweatypalmfallstomychestinafutileattemptatdiscouragingaswell ofpanicfromrising.Inmyfailuretoplanthis adventure,itneveroccurredtomethatImightbedraggingLukeintoanuncomfortableposition.Afterall,hedidn’taskforthis. “I’msorry,”Isay,gettingtomyfeet.“Ishouldn’thavecomehere.Ididn’tthink ” “Sitdown,Pumpkin”Hiseyestwinkle “Youtalktoomuchwhenyou’renervous” Mychestburns,lingeringonmynicknamefromwhenwewereyounger.Isitasrequestedandstruggletocatchmybreath. “Idon’twanttobringyouintothis,”Isay “Lookslikeit’salittletoolateforthat.”Hesmirks.“You’resafehere.Youknowthat.” Everymusclerelaxes,andIsinkintothemostuncomfortablecouchintheuniverse.Butitdoesn’tmatterhowmanysprings pokemybutt.Itdoesn’tmatterifLukecanprotectme orifheshould.Theonlythingthatmattersisthathewouldtry.Even afteralltheseyears,hewouldstilloffermerefuge.Icancountonhim.
Igrin Just like I knew I could “Seriously,though,”hesays,liftingabrow.“Iimaginethere’sapissed-offmoviestarwithasecurityteamstraightoutofa
combat zone searchingPeachwood Countyfor a runawaybride right about now It’s not that I couldn’t take them I’mjust wonderingifIneedtocallforreinforcements.”
Ilaugh “IfbyreinforcementsyoumeanGavin,youmightbebetteroffonyourown IrememberwhenGavinplayeddeadin themudpitsinsteadofhelpingyoutalktothepoliceaboutwhywewereouttherepastdark.” Lukelaughs,too,anddisappearsaroundthecorner “Ihaven’tthoughtaboutthatinalongtime” “Ican’tthinkofGavinandnotthinkaboutit.”
“Serveshimrighttohavethatashislegacy Littleshit”Iceclinksagainstaglass “Backtothetopicathand Doesanyone knowyou’rehere?”Hepokeshisheadaroundthecorner.“Whyare youhere,anyway?”
Mythroatgoesdry,andI’msuddenlyawareofeveryriseandfallofmychest.Hewatchesmeforthelongesttime,giving meachancetoanswer Finally,ashadowfallsacrosshisface,andhedisappearsagain “Let’sbackup,”hesays,roundingthecornerwithtwoglassesoftea.“Howthehelldidyougetinmyhousetostartwith?”
“Keyintheboot”
“How’dyouknowaboutthat?”
Itake the glass fromhim “I’mthe one who putthe keyinthe bootthe firsttime Icreated thathidingspot Ijusttooka chancethatyouareacreatureofhabitandstruckgold.”
“Damn.Iprobablyoughtamovethat,huh?”
“Might not be a bad idea” Especially if some of his other exes turn up out of the blue Can’t say I love that idea Strangely.
Hesitsonthechairacrossthecoffeetableandtakesadrink Iwonderwhathe’sthinkingwiththatglimmerinhiseye,butI don’task.I’mnotexactlyinthedriver’sseat.
Thesunstreamsinthewindows,fillingthelivingroomwithabrightwarmththatseepsintoeverycorner.Thishousehas always had a tranquilityaboutit. Before Poppypassed awayand we’d come here so Luke could help his grandfather inthe barn,itwasalwayssopeaceful.Nomatterthestressathome,ordramaatschool,orworriesaboutwhateverdeal myfather wastryingtomakeonmybehalf,itallmeltedawayinthishouse
“Okay,so letme getthis straight,” Luke says.“You’re notgettingmarried and fled the scene. Thenyoushowed up here, performedafelonytogetintomyhouse,andnow what?”
Ismilesheepishly.“Ikindof… don’t haveaplan.”
“Soyoujusttiedmeupinoneofyourshenanigansthatwillbeoneoftheyear'sbiggestscandals.Awesome.” “Oh,don’tactlikeyoudon’tloveagoodshenanigan.”
“Notthepoint,”hesays,grinning.“Ialsoloveagoodtie-up,butthat’snotthepointeither.”
Mystomachmusclescontractattheheatinhisgaze “Ididn’tknowwhereelsetogo” “Hey, it’s not bad for my ego that I was the only person you could think of when you were running fromTomfucking Waverly”
Ismirk.“IsaidIcouldn’tthinkofanywhereelsetogo.Notwho else. ” “Okay.”Herollshiseyes.“Howmanyhousesdoyouownagain?”
“Howdidyousayit? Not the point ”
Weexchangeasmallsmilethatfillsmewithbigemotions namely,comfort. LukeandIcould’vebeenaperfectmatchinanothertimeandplace I’ve replayed the daywe broke up more times thanI’ve replayed anyother eventofmylife. Thatmomentimpacted me more than any charity work, music award, or concert I’ve ever performed A sunny afternoon, Luke in black-and-yellow flannel,standinginhisparents’driveway.Lukedidn’taskmetostaywithhim,andIdidn’taskhimtogo.It’shauntedmeever since.Butaftereachreview,I’mleftwiththesameconclusion:itendedtheonlywayitcould’ve.
Irestmyglassonmydressasalumprisesinmythroat “Ican’tgotoanyofmyhomes Tom’steamiscraftinghisimagesavingstatementas we speak, and itwill notdo me anyfavors. The paparazzi will case myhouses and the airport. They’ll evendispatchreporterstoplacestheythink Imightgo”
“Whereareyougoingtogo?”
Igulp “Idon’tknow MaybeIcouldstayhere?”
ThewordsflyoutofmymouthbeforeIcanstopthem. Before I can think them through.Mybrainformssentencesandtells mylipstosaythem,tobacktrackmywordvomitandsaveface.Butmyheart, my stupid, stupid heart,blockadestheeffort.
Mychest burns withanticipationas I watchLuke take a piece of gumfromhis pocket, put it into his mouth, and chew deliberately.Hisgazeholdsminewithsuspicion,fire,andsomethingelseIcan’tquitename.Themixturefeedsthepanginmy chest
“Ithinkyoustayinghere would be the worstidea you’ve ever had,” he says after a longpause. “And you’ve had some epicallyshittyones.”
“Nowyou’rejustbeingadick.”
“Wantmetorattleoffafew?Fine,”hesaysbeforeIcananswer.“YouboughtacarfromamanknownasLemonadeLarry
becauseallhesoldwaslemons.”
“Okay,butyoutriedtodragraceacop.That’sevendumber.”
“You tried to polar plunge in Peachwood Creek in a bikini and ended up falling on the ice and giving yourself a concussion.”
“Fine, butyouranbuttnaked throughthe middle oftownto celebrate the football teamgoingto the state finals and got blackmailedbyastrangerwhomayormaynothavehadpicturesofyouperformingtheElectricSlideonMainStreetinnothing butajockstrap”
Henarrowshiseyes.“Therewasalcoholinvolved.”
Inarrowminerightback.“Likethat’sanexcuse.”
Slowly,ourlipscurveintoasmile,andbeforeweknowit,we’relaughing “CanIstay?”Iask.
“No You’llcrampmystyle”
“Youdon’thave astyle.”
Hetakesoutanotherpieceofgumandpopsitintohismouth
“I’llpayrent,”Isayassweetlyaspossible.
“Rent?Howlongareyoutalkingabout?Ihavealife,youknow.”
“Itoldyou Ididn’tplanthisout”
“Clearly.”Hegetstohisfeetandmovestothekitchendoorway.“Ican’ttakeyouseriouslyinthatthing.”
“Inwhatthing?”
Hiseyesscanthelengthofme.“It’sso…fluffy.”
“So?”
Heshrugs.“Ineverpicturedyouinafluffyweddingdress.” “Butyoudidpicturemeinone,justnotlikethis?”
“Theoretically”
Colorflamesmycheeks.“Well,I’dchange,butIhavenothingelsetoputon.Ormyphonetocallanyone.Ormycreditcard toordersomething”Ifallbackintothecushions,wincing “I’msorryIgotyouintothismess”
Heexhalesroughlyandwalksmyway.Hisfeaturesarewithouttheplayfulnessofafewminutesago.He’sserious sober andmyheartpounds.
Lukestopsinfrontofmewithhishandsslunginhispockets.Thesunkisseshisshorthair,highlightinghow muchdarker it’sgottensinceIlastsawhim.AllIwanttodoisreachforhim,havehimpullmeintohisarms,andtellmeit’llallbeokay. ButIdon’t
“I’lltellyouwhat,”hesays,hisvoicelowandgravelly.“Ineedtogotothebarnforalittlebit.Ihaveafewthingstodo. Whydon’tyougofindsomethingelsetowear?We’lltalkwhenIgetback,andyouaren’tdressedlikeyou’regettingreadyto marrysomeoneelse.”
“ItoldyouIdon’thaveanything.”
HeturnsbeforeIcanreadhisfeaturesandgrabshisphone “Well,youfiguredouthowtobreakintomyhouse Prettysure youcanfigureouthowtobreakintomycloset.”
Laughter falls frommylips as he disappears into the kitchenagain The slidingglass door thatleads to the backofthe houseopensandthencloses. That was easy.
This could’ve gone so differently Luke could’ve been an asshole, and it would’ve been justified Maybe our breakup wasn’tcontentious,butIam hisex-girlfriend.EventhoughIhaven’tseenaseriousgirlfriendorawifeonhissocialmedia,that doesn’tmeanonedoesn’texist.Withoutawomaninhislife,hestillcould’vebeenpissedthatIwaltzedintohishousewithout somuchasahello Lukecould’vewalkedstraightoutthedooraftertellingmetogetoutandIcouldn’thaveblamedhim Igrin. But he didn’t.
He was Luke, the easygoing, good-natured, gold-hearted manwho would give youthe shirt off his back Or out of his closet. It’s no wonder I once loved this man.
Thestillnessdescendsuponmeagainalmostimmediately Thistime,itdoesn’tfeellikeitwillswallowmewhole Instead, it’salmostagift.It’sspaceformetogetmyheadtogetherandfigureoutwhattodo.
Iglancedownatthefabricpoolingallaroundme.
“Firstthingsfirst,”Isay,settingmyglassonthetable “Let’sgetoutofthisthing” IheadupstairstoLuke’sroom.
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FIG. 343
Subclavicular dislocation. (Lejars.)
Subcoracoid dislocation. (Lejars.)
In the downward or subglenoid luxations the capsule is lacerated lower down. These displacements occur when the shoulder has been
FIG. 344
dislocated with the arm in the extended and elevated position. Here the head of the humerus is found in the axilla, resting against the border of the scapula, and the axillary structures, especially the circumflex nerve, usually sutler, while the external rotators are either ruptured or their insertions detached (Fig. 345).
The posterior or subspinousdislocation is the least common of all. In its production the arm is apparently adducted and the elbow raised. Here the humeral head is found beneath the posterior surface of the acromion or beneath the spine of the scapula (Fig. 341).
Symptoms.
—The indications of shoulder dislocation are pain; flattening of the shoulder; undue prominence of the acromion; depression opposite the glenoid cavity, with loss of the rounded contour due to the presence therein of the head of the humerus; appearanceofamoreorlessglobularmassin the position now abnormally occupied by the head of the humerus; changeinthe axisof this latter bone; inabilitytobringtheelbowtotheside; more or less complete loss of function, and more or less spasm of the
Subglenoid dislocation. (Lejars.)
muscles about the joint. Owing to the fact that the thorax presents a curved or warped surface, to which a straight line can be tangent only at one point, it results that the handoftheinjuredsidecannot be made to wrap itself over the opposite shoulder while its elbow stilltouchesthechestorside(Dugas’ test).
Diagnosis.
—As between fracture and dislocation the surgeon may be greatly helped by deciding that the head of the humerus is still in its proper position; that the deltoid is not flattened as in dislocation; that the arm is shortened rather than lengthened; that motility is increased rather than diminished; that bony crepitus is usually obtainable, and that replacement, which may be comparatively easily secured, is maintained only so long as the parts are held in position by the operator’s hands. An additional sign of value is the fact that a straight edge cannot ordinarily be made to touch the tip of the acromion and the external condyle of the humerus at the same time, because of the protrusion caused by the presence of the head of the humerus in its socket. When the straight edge can be so applied it must be either because the head of the bone is out of the socket or the upper end of the bone broken. A still more crucial test which should, however, only be applied when others prove unsatisfactory, may be furnished by passing a sterilized hat-pin through the sterilized skin over what seems to be the displaced head of the bone and into the globular mass. Rotation of the humerus will then cause its end or head to make an excursion which will be quite distinctive.
Exhibits a subcoracoid dislocation and the position of the patient in his endeavor to find relief from pain. (Mudd.)
Treatment.
—Prompt reduction is the only treatment for shoulder or other dislocations. This may be first attempted without anesthesia. Should muscle spasm prevent easy reduction it should be relaxed by an anesthetic, for which purpose nitrous oxide will often suffice. In the forward or forward and downward dislocations it will sometimes be sufficient to simply make firm traction in a direction obliquely outward and upward, with rotation. When this is insufficient it may be assumed that there is more or less laceration of the capsule and entanglement of the head of the bone, as well as that it is caught around the border of the glenoid cavity, against which it is firmly held.
The above simple maneuver failing, the luxation is to be reduced by a more scientific manipulation, in which traction figures largely, the method now generally in vogue being that suggested by Kocher,
by which rotation and leverage are added to traction, and a minimum of power made to do a maximum of good. Kocher’s method is especially applicable to the anterior displacements. It consists of a triple manipulation whose three stages are portrayed in Figs. 347 to 349. The first procedure is to flex the forearm to a right angle with the arm, apply the former firmly to the side, and then, while keeping the elbow at the side, forcibly rotate the limb outward until the forearm points away from the body (Fig. 348). This having been done the arm is abducted and the elbow moved upward until the limb is in the horizontal plane of the shoulder, the scapula being held firmly during these movements, as shown in Fig. 348. After the arm has been brought to the level of the shoulder it is rotated inward and brought downward by a process of circumduction, the elbow being made to describe some part of the arc of a circle as it comes down. The displaced head should slip into place during this movement, and will do so unless the capsular tear is too small. In that case the movements should be repeated, perhaps with more force, until the opening is sufficiently enlarged to permit the buttonhole in the capsule to slip over the head of the bone.
First position in Kocher’s rotation method.
Arm is being carried forward and upward toward second position.
Completion of third movement in Kocher’s method.
This method of manipulation, with such modification as circumstances may require, or such addition as pressure with the hand or fingers of the assistant, has superseded all the older more crude and forceful methods, and proves sufficiently applicable for all cases. It is assumed that the operator has sufficient judgment to modify any method to fit the exigencies of a given case, else he should not proceed with it. For instance, in the axillary dislocations upward traction affords valuable assistance. In the subspinous form the arm is raised to a level while extension is made upward and forward. In other words, all these methods depend upon the combination of traction, rotation, and leverage. The old method of Astley Cooper, with the foot in the axilla, the shoe having been removed, coupled with traction upon the arm and swaying movements, combined with rotation, abduction, and adduction, may be made effective, but is not nearly as elegant as the simpler manipulation above described. On the other hand, old, unreduced dislocations, complicated with adhesions, are often exceedingly difficult.
In rare instances dislocations several months old have been reduced after adhesions have been broken up by more or less violent manipulations. When forcible efforts of this kind prove futile fair restoration of function may be obtained by maintaining regular motion, at first passive, later active, to prevent reformation of adhesions, the head of the bone gradually forming a new and false socket for itself. Finally, the method of excision can be employed should occasion demand. The experience of a number of surgeons has shown that in old cases, or those impossible of reduction by justifiable force, an open division of the joint, with severance of those tissues which prevent reduction, may be profitably, safely, and satisfactorily practised. Porter and McBurney, among the American surgeons, have devised a corkscrew instrument which may be driven into the head of the bone, by which manipulation after arthrotomy is materially facilitated.
The simultaneousoccurrence offracture anddislocationhas been treated of in the previous chapter. When difficulty presents the best result will be obtained by open incision, replacement of the head of
the humerus, and fixation of fragments by sutures, wire or otherwise. If seen late the upper fragment should be removed. The possibilities of aseptic surgery have led to the abandonment of the old method of first permitting the fracture to unite and then attempting to reduce dislocation.
Physiological rest is the essential feature of the after-treatment of all these cases, a sling and a retentive bandage being sufficient for the purpose. Function should be restored by an increasing degree of motion.
One of the most serious complications of shoulder dislocations is deltoidparalysisfrom injury to the circumflex nerve. The momentary pressure of the head of the bone upon the nerve is sufficient to more or less permanently impair its function. In its medicolegal aspect it should always be maintained that the surgeon is never to blame for the accident, and is only to some degree blamable in case he has failed to diagnose the dislocation so soon as opportunity was afforded and has thus permitted prolonged pressure to possibly intensify the effect which has already been produced by the injury. [42]
[42] The shoulder is liable to numerous injuries that produce disability. Pain in some of these conditions may be almost constant and spread upward to the neck and be aggravated by even passive motion. Loss of power varies from moderate paresis to complete paralysis. When the circumflex nerve is especially involved it is the deltoid which shows the effects. More severe injuries may involve the muscles of the arm and the forearm. Muscle atrophy may be greater than can ordinarily be accounted for by mere disease. In rheumatic patients a dry synovitis may be added to the other complications. Most of these features are due to traumatic neuritis. When aggravated they may result from rupture of nerves or cicatricial formations around them. The best treatment consists of immobilization for three or four weeks to favor nerve repair, counterirritation, especially with the flying cautery, over the roots of the branchial plexus, with massage, electricity, and even deep injections of strychnine to stimulate the paralyzed muscles. When paralysis is persistent and scar tissue seems to press upon nerves, exposure of the plexus and freeing its branches from all source of pressure will be necessary. DISLOCATIONS OF
The irregularities of the elbow-joint have permitted a complicated dovetailing of its component parts which would seem to make dislocations almost impossible without fracture. Nevertheless, and especially in the tender years of childhood, both bones may be dislocated in either direction, or either bone of the forearm alone in any direction save toward the other. Diagnosis will be greatly aided by observance of the anatomical facts stated in the section on fractures of the elbow-joint and by an estimate of the relative positions occupied by these bony landmarks. When, however, intense swelling prevents this then we should either wait for its subsidence or depend upon a skiagram.
The most common dislocation is that of bothbonesbackward, one of the possible consequences of a fall upon the extended arm and palm of the hand. The coronoid process may rest beneath the joint end of the humerus, making the dislocation incomplete, or back of it, making it complete. If the coronoid process has been broken off the dislocation can be made and reduced as often as desired. The fan-shaped lateral ligaments are always more or less lacerated. The arm will be partially bent and there will be prominent deformity upon the posterior aspect of the joint while the axes respectively of the arm and the forearm will be somewhat disturbed. Usually the lower end of the humerus can be felt in front of the normal situation of the elbow-joint (Figs. 350, 351 and 352).
Reduction is more or less easily accomplished by traction with an easy movement, by which the upper end of the forearm shall be directed toward its proper position.
Lateral displacements result also from falls in extreme positions. Lateral dislocations are rare and the result of violence, and may compel amputation. In these cases the lateral diameter of the joint is markedly increased, while the normal relation of the condyles to the olecranon is greatly altered. In these cases movement is painful and limited.
Backward dislocation of both bones. (Lejars.)
Outward displacement of both bones. (Lejars.)
The ulna alone may be dislocated backward, in which case the orbicular ligament must be lacerated and the upper ends of the adjoining bones forcibly separated. The olecranon will present back
FIG. 350
FIG. 351
of its proper position, while the head of the radius will rotate where it belongs.
Dislocation forward and outward of head of radius. (Lejars.)
Anterior dislocation of both bones is exceedingly rare unless complicated by fractures of the olecranon. When thus injured the forearm is lengthened and fixed. The posterior surface of the humerus here has only a skin covering, the condyles are bulging, the olecranon fossa empty, and the upper ends of the forearm bones felt in front of the elbow.
The head of the radius alone may be displaced in any direction save toward the ulna. The forwarddislocation is the most common, which may be produced by a fall upon the overextended and pronated hand. The orbicular ligament here is lacerated or the head of the radius is slipped out of it. In the latter case it may be difficult to replace it. When dislocated backward the capsule is torn posteriorly as well as the orbicular ligament (Fig. 353).
Position of the bones in an old unreduced dislocation forward of the radius. (Erichsen.)
Treatment.
The treatment of elbow dislocations is based upon general and but slightly differing principles. It consists of a combination of traction with sufficient force, made with one hand, while with the other pressure should be made upon one or both bones in the desired direction; at the same time by a combination of swaying and rotary movements more or less massage may be given to the parts, by which complete reduction may be more easily effected. Anesthesia is nearly always necessary, not alone for the relief of pain, but to produce muscular relaxation, by which manipulation is materially assisted.
A peculiar form of dislocation of the head of the radius in young children has received considerable attention. It is produced by a firm pull upon the wrist or forearm, as in lifting or jerking a child by the forearm or hand. Pronation of the hand is usually a feature of the injury. It is probable that the head of the bone is pulled out of the orbicular ligament and displaced forward. The forearm is slightly flexed, movements of the elbow are very free, except that supination of the forearm meets with resistance. The displacement is rectified by a forced supination with traction. An epiphyseal separation of the head may simulate this injury. Such cases necessitate a few days’ rest in a splint, with the arm flexed and supinated, although recovery often occurs without particular restraint.
DISLOCATIONS OF THE WRIST AND HAND.
Wrist dislocations are rare, the posteriorbeing more frequent than the anterior. It simulates the deformity of a Colles fracture, and is produced in a similar way. The deformity is more marked, the outlines of the various bones more distinct, except in front, where they may be masked by the flexor tendons. There is no alteration in the relations of the styloid processes. The forward dislocation may possibly simulate Smith’s fracture, the symptoms being the reverse of those above mentioned.
Firm traction, with pressure in the proper direction upon the carpus, will suffice for reduction of these cases. The subsequent dressing may be practically that of a Colles fracture.
The lower ends of the ulna and radius are sometimes dislocated from their proper relations. Reduction is easy, but rest and restraint are required for some time until the ligaments have recovered their tonus.
Of the carpus the os magnum is the only one likely to be displaced, it being occasionally forced backward so that it forms a projection on the dorsum of the hand. It requires extreme force to displace the carpal bones, enough frequently to produce other injuries at the same time, some of which may be compound. A carpal bone which cannot be reduced to position by pressure may be safely removed through an incision.
Of the carpometacarpal dislocations, the thumb is the most frequently displaced, usually in a backward direction. Traction and pressure suffice for its reduction. When the bone is forced forward it is usually as the result of direct violence. Wherever the base of the bone may rest it is easily detected, while pressure with traction suffices for its replacement.
Of the dislocations of the phalangesupon the metacarpus those of the thumb are the more frequent. This may occur as the result of a fall, by which the thumb is forced backward into a position of hyperextension. Nearly all of these dislocations are accompanied by a rupture of capsule. Those of the thumb are difficult of reduction; this appears to be due to the tendons of the short flexor, which surround the head of the metacarpal bone. The sesamoid bones also
furnish a source of difficulty, while the long tendons, when contracted by their respective muscles, increase it (Fig. 354).
FIG. 354
Metacarpophalangeal dislocation.
Treatment, especially of the thumb dislocations, is facilitated by first exaggerating the abnormal position, then making traction and pressure in the proper direction at the same time. Special forceps have been devised for seizing and holding the digits, or a clove-hitch can be thrown over the thumb or finger. Extension should not be first made in the axis of the metacarpal bone, but rather at an abruptangle to it in order to relieve the expanded phalangeal end. The majority of writers concede that in some cases reduction is practically impossible. When effort has proved futile the parts should be sterilized and incised, the incision being utilized for open reduction or for excision, as deemed best.
Dislocations of the other phalanges are usually easily recognized and treated by traction and pressure.
