Hand and Wrist X-Ray with Dr. Dang

Missed orthopedic fractures account for the largest source of malpractice claims and hand injuries account for 5-10% of ED visits.

ABCS method for Interpretation

A: adequacy/alignment. Correct patient and limb with full image without ulnar or radial deviation

B: bones. Need at least 2 views

C; cartilage and clear spaces. All joints should be uniform

S: soft tissues

Tuft fracture: typically due to crush injury

No specific treatment. Can splint for comfort

Nail bed injury = open fracture and need antibiotics

Mallet finger: forced flexion of extended DIP joint

Can be associated with small avulsion fracture

Splint in hyperextension

Jersey finger: forced extension at flexed DIP

Won't be able to fully flex at DIP

Surgical management

Skier's thumb: hyperabduction of thumb with FOOSH

Thumb spica splint

Boxer's fracture: metacarpal neck fracture with volar angulation

Make sure this is not a fight bite: need antibiotics

Metacarpal neck fractures: need to know degree of angulation as it determines need for ORIF

Scaphoid fracture: most common fractured hand bone

Tenderness of anatomic snuff box or with axial loading of thumb

30% may not be apparent on initial x-ray

Increased risk of AVN, so splint and follow up for repeat imaging

Triquetrum fracture: can be associated with ulnar nerve injury, splint with a polar wrist splint

Scapholunate dissociation: injury to the ligament connecting the 2 bones