Radiology Review

Hand Slammed in Door

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A 48-year-old woman presents to the urgent care center with complaints of right hand pain second-ary to an injury she sustained earlier in the day. Her hand was accidentally caught in a metal door as it was being shut by someone else. The door struck her in the middorsal aspect of her hand. She is now complaining of pain and swelling. She is healthy except for mild but well-controlled hypertension. Her vital signs are normal. Examina-tion of her right hand shows mild to moderate soft tissue swelling and some early bruising. There is extreme tenderness over the fourth and fifth metacarpal bones. Good capillary refill time is noted, and sensation is intact. She is able to flex her fingers somewhat, although this is limited by the swelling. Radiograph of the right hand is obtained. What is your impression?


 

ANSWER
The radiograph shows a comminuted fracture of the proximal fifth phalanx. Soft tissue swelling is noted as well. The patient’s hand was splinted, and arrangements for outpatient orthopedic follow-up were made.

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