Ortho Case of the Week – Hand ANSWERS
Case 1: 21-year-old male with presents with right hand pain and swelling after punching a wall.
1. What is your read of the x-ray below? What is this fracture also called?
Fifth metacarpal neck fracture with palmar angulation of the distal fracture fragment, no intra-articular extension. AKA a boxer’s fracture.
2. How would you manage this patient? What type of splint would you use?
Closed reduction (video) and splinting with a ulnar gutter splint (video).
3. How much angulation is acceptable post-reduction?
On the 5th digit, up to 40 degrees of angulation is acceptable. This decreases with each digit, with 10-20 degrees acceptable for the index and middle fingers. Note that there can be no rotational deformity.
Case 2: A 24-year-old male presents unable to extend at his middle finger DIP after being struck in the hand by a baseball. His astute memory notes that he was struck a the tip with his finger extended.
1. What is the diagnosis?
Mallet finger. X-ray shows an intra-articular avulsion fracture through the dorsal aspect of the phalangeal base.
2. How would you manage this patient?
Splint the DIP joint in continuous slight hyperextension for 6-8 weeks. 24 hours a day, 7 days a week. Do not splint the PIP! Inadvertently splinting PIP for 6 weeks results in collateral ligamentous overgrowth and functional disability.
