Give a Hand
When a fall or crushing blow causes hand trauma, the injury can result in a fracture. Decipher these emergency radiographs to determine what needs attention.
Match the diagnosis to the photo by letter
a. Proximal fifth phalanx
b. Distal fourth metacarpal head
c. Scaphoid bone
d. Styloid process of the radius
For answers, see next issue; for discussion, go to www.mdedge.com/clinicianreviews/articles/picture
3. The middorsal aspect of a 48-year-old woman’s right hand was accidentally caught in a metal door as it was being shut. Examination shows mild to moderate soft tissue swelling and some early bruising. There is extreme tenderness over the fourth and fifth metacarpal bones. Although limited by swelling, she can flex her fingers somewhat.
Diagnosis: 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.
,For more information, see “Hand Slammed in Door.” Clinician Reviews. 2013 May;23(5):20.
