It is Saturday night and you have just seen a 25 year old with punch injury to his right hand. The x-ray of the hand is as follows. What can you see?
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The x-ray shows significant soft tissue swelling. There is a short oblique fracture of the base of the proximal phalanx of the 5th metacarpal which is almost hidden by the skin fold unless one looks carefully. The fracture is extraarticular.
Rotational finger deformity associated with this type of fracture can be clinically checked by asking the patient to make a fist, when all the finger tips should be pointing towards the proximal pole of scaphoid.
They all need referral to hand surgeon from ED.
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