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A painful swollen hand

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Q1: What are the features seen on the radiograph?

The radiograph shows soft tissue swelling around the third and fourth metacarpal and a possible fracture of the third metacarpal shaft.

Q2: What other investigation is required?

A further radiograph (fig 1, above) of the hand in oblique view, which shows the fracture clearly.

Figure 1

 Radiograph of hand (oblique view).

Q3: What is the likely diagnosis?

Long spiral fracture of the shaft of the third metacarpal bone.

Q4: What is the line of management?

Splinting of the hand using a volar back slab for four weeks and early physiotherapy is recommended.

Fractures of the shaft of the metacarpals

Fractures of the hand, especially the dominant hand, are an important group of injuries. They need proper assessment and management. Neglected injuries and improperly treated injuries can result in devastating complications and early arthritic changes can lead to loss of functional life years. Hundreds of hand injuries are seen daily in accident and emergency departments across the country. This case highlights the importance of proper assessment and need for the gold standard two views in radiographs for any hand injuries, so that the fracture can be identified in one or the other plane and appropriate treatment can be instituted without any delay.

Fractures of the metacarpal can involve the head, neck, the shaft or the base. Intra-articular fractures need anatomical reduction and proper fixation to prevent early onset osteoarthritis.1 Fractures of the shaft can be treated conservatively by splinting appropriately and early mobilisation. Displaced fractures and unstable fracture configurations can be dealt with by early internal screw fixation. Involvement of a specialist hand physiotherapist is extremely important.

Final diagnosis

Long spiral fracture of the shaft of the third metacarpal bone.

Reference

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