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A painful swollen hand
  1. K Selvarajan,
  2. R Vadivelu,
  3. A L Armstrong
  1. Department of Trauma and Orthopaedics, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
  1. Correspondence to:
 Mr Vadivelu

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Answers on p 371.

A 30 year old, right handed man presented to the fracture clinic with an painful swollen left hand 24 hours after a fall. He was able to make a fist and straighten his fingers. A radiograph of his hand performed in the accident and emergency department during his initial consultation is shown in fig 1.

Figure 1

 Radiograph of hand (anteroposterior view).

Clinical examination revealed a swollen tender left hand, especially over the middle metacarpal bone. His range of movement in the middle metacarpophalangeal joint was slightly diminished.


  1. What are the features seen on the radiograph?

  2. What other investigation is required?

  3. What is the likely diagnosis?

  4. What is the line of management?

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