Presentation
Punched wall (again).
Patient Data
There is dorsal dislocation of the third to fifth metacarpals at the carpometacarpal joints. On the lateral projection, there are two small osseous fragments that project dorsal to the distal carpal row. These presumably represent acute fracture fragments however the donor site is not clearly appreciated on these views.
The third to fifth metacarpals are dorsally dislocated from their articulations with the capitate and hamate. Alignment of the second metacarpal with the trapezoid and the first metacarpal with the trapezium is normal. There are fractures through the base of the third and fifth metacarpal bones. There is a fracture through the dorsal surface of the hamate, as well as a likely fracture through the dorsal surface of the capitate. There are multiple small fracture fragments that lie adjacent to the bases of the third to fifth metacarpals, most numerous around the base of the third metacarpal.
Allowing for slight dorsi flexion at the wrist, alignment of the carpal bones is within normal limits. No distal radius or ulnar fracture. Volar plaster in situ.
Case Discussion
Punching walls is a favorite pass time for emergency room frequent flyers, and usually results in a boxer fracture. This chap must have tried harder than normal.
Unable to process the form. Check for errors and try again.