Presentation
History of psoriasis and vitamin D deficiency. The patient presented to the ED after an altercation where the patient was bitten on the left hand.
Patient Data
1. Ununited oblique fracture of distal left metacarpus #5 with moderate calcifications on the proximal side of the metacarpus.
2. Incomplete ventral subluxation of left distal phalangeal base #5.
3. Moderate degenerative changes of left radiocarpal and left proximal interphalangeal joint #5.
4. No osteolytic lesion, bony erosion or abnormal soft tissue densities.
Case Discussion
Fifth metacarpal fractures are known as "boxer's fractures", as they often occur due to punching a solid object 2. Metacarpal fractures generally occur in patients ages 10-40 and are more likely to occur in men 3. The causes of these fractures include a punching mechanism or a fall directly onto the hand, and they typically occur in athletic events, as an occupational hazard or in fights.
Radiographs of the hand (AP, lateral and oblique) are usually enough to confirm the diagnosis. Many factors are considered to determine conservative versus operative treatment; intra-articular fractures and severe comminution or angulation require surgical intervention (open fixation, internal reduction) 1. Open fractures will also need antibiotics and tetanus prophylaxis; "fight bite" injuries, as in this patient, may also require irrigation and surgical debridement of the MCP joint1.
The calcifications noted at the fracture site suggest that at least a moderate amount of time had passed since the injury. The moderate degenerative changes seen in the proximal interphalangeal joint are likely related to the patient's psoriasis and vitamin D deficiency.
This case was submitted with supervision and input from:
Soni C. Chawla, M.D.
Health Sciences Clinical Professor,
Department of Radiological Sciences,
David Geffen School of Medicine at UCLA.
Attending Radiologist,
Olive View - UCLA Medical Center.
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