An 80-year-old male presents with severe right arm pain after he tripped and fell down 2 steps. Examination shows deformity and swelling to his right upper arm. You obtain AP and lateral humerus x-rays as above.
A 27-year-old female presents with left knee pain after a low-speed motor vehicle collision in which her knee hit the dashboard. She is tender over the patella without significant effusion and has an intact extensor mechanism. The above x-ray was obtained (Image 1. X-ray left knee. Case courtesy of Dr. M. Mourits, Radiopaedia.org, rID: 14476).
A 27-year-old male presents to the ED with left hand pain after punching a wall. He has pain and swelling on the ulnar side of the dorsal hand. The above hand radiographs were obtained (image courtesy of Mark Hopkins).
This patient has a fracture of the 5th metacarpal neck, otherwise known as a Boxer’s fracture. It is so named because a majority of these fractures come from punching an object [1].
1. Skin:
2. Angulation:
3. Neurovascular:
4. Rotational Alignment:
Opinions vary, but most agree that any angulation beyond 30 degrees at the metacarpal neck requires reduction [1].
Patients should be placed in an ulnar gutter splint. They can follow up with a hand specialist as determined by institutional policy as an outpatient in 1 week.
Looking to bone up in general? Check out the SplintER archives. Want more information on hand radiographs? Check out SplintER Series: Case of a First Metacarpal Fracture or Trick of the Trade: Reducing the metacarpal neck fracture.