Acute 4th metacarpal and old 5th metacarpal fractures
Punch injury. Tender 3rd - 5th metacarpals.
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Acute mildly impacted fracture of the fourth metacarpal neck with volar angulation and shortening. The fourth MCP joint is normally aligned. No third or second metacarpal fracture.
Volar bowing of the fifth metacarpal shaft with shortening and associated remodeling indicates an old injury.
Fractures of the 4th and 5th metacarpals are common punching injuries. This patient had a history of multiple episodes of punching things and people, and the bowing deformity of the 5th metacarpal represents a previous heaed fracture.