Give a Hand

1. A 45-year-old construction worker accidentally fell 20 ft from a scaffolding. He is unable to flex or extend his right wrist due to pain. Examination of the wrist shows a moderate amount of soft-tissue swelling with moderate tenderness along the base of the first metacarpal.

Diagnosis: The radiograph shows an acute, comminuted fracture of the scaphoid bone. The patient was placed in a thumb spica splint and sling. He was instructed to follow up in one to two days with the hand surgeon who was on call, with anticipation of subsequent open reduction and internal fixation.

For more information, see “Construction Worker Falls From Scaffolding.” Clinician Reviews. 2013;23(11):15.

2. A 90-year-old man “just passed out” in his yard, landing in an ant nest. He experiences bilateral wrist pain, presumably from multiple ant bites. Both wrists are tender; range of motion causes tenderness. Inspection demonstrates mild to moderate circumferential swelling with several raised, reddened bumps.

Diagnosis: The radiograph shows some osteopenia and significant vascular calcifications. Of note, there is a fracture of the styloid process of the radius, extending slightly to the joint space. The patient was placed in a splint and orthopedic referral was obtained.

Wrist Pain After a Fall. Clinician Reviews. 2012;22(9):22.

3. The middorsal aspect of a 48-year-old woman’s right hand was accidentally caught in a metal door as it was being shut. Examination shows mild to moderate soft tissue swelling and some early bruising. There is extreme tenderness over the fourth and fifth metacarpal bones. Although limited by swelling, she can flex her fingers somewhat.

Diagnosis: The radiograph shows a comminuted fracture of the proximal fifth phalanx. Soft tissue swelling is noted as well. The patient’s hand was splinted, and arrangements for outpatient orthopedic follow-up were made.

For more information, see “Hand Slammed in Door.” Clinician Reviews. 2013 May;23(5):20.

4. A trauma patient arrives in your facility after a motor vehicle collision. His right hand and wrist appear to be moderately swollen, and he has been placed in a splint.

Diagnosis: The radiograph shows a slightly displaced fracture of the distal fourth metacarpal head. No other injuries are present.

The patient’s hand was left in the splint, and orthopedic evaluation was obtained.

For more information, see “Secondary Survey of Trauma Patient.” Clinician Reviews. 2015;25(12):10,35.

1. A 45-year-old construction worker accidentally fell 20 ft from a scaffolding. He is unable to flex or extend his right wrist due to pain. Examination of the wrist shows a moderate amount of soft-tissue swelling with moderate tenderness along the base of the first metacarpal.

Diagnosis: The radiograph shows an acute, comminuted fracture of the scaphoid bone. The patient was placed in a thumb spica splint and sling. He was instructed to follow up in one to two days with the hand surgeon who was on call, with anticipation of subsequent open reduction and internal fixation.

For more information, see “Construction Worker Falls From Scaffolding.” Clinician Reviews. 2013;23(11):15.

2. A 90-year-old man “just passed out” in his yard, landing in an ant nest. He experiences bilateral wrist pain, presumably from multiple ant bites. Both wrists are tender; range of motion causes tenderness. Inspection demonstrates mild to moderate circumferential swelling with several raised, reddened bumps.

Diagnosis: The radiograph shows some osteopenia and significant vascular calcifications. Of note, there is a fracture of the styloid process of the radius, extending slightly to the joint space. The patient was placed in a splint and orthopedic referral was obtained.

Wrist Pain After a Fall. Clinician Reviews. 2012;22(9):22.

3. The middorsal aspect of a 48-year-old woman’s right hand was accidentally caught in a metal door as it was being shut. Examination shows mild to moderate soft tissue swelling and some early bruising. There is extreme tenderness over the fourth and fifth metacarpal bones. Although limited by swelling, she can flex her fingers somewhat.

Diagnosis: The radiograph shows a comminuted fracture of the proximal fifth phalanx. Soft tissue swelling is noted as well. The patient’s hand was splinted, and arrangements for outpatient orthopedic follow-up were made.

For more information, see “Hand Slammed in Door.” Clinician Reviews. 2013 May;23(5):20.

4. A trauma patient arrives in your facility after a motor vehicle collision. His right hand and wrist appear to be moderately swollen, and he has been placed in a splint.

Diagnosis: The radiograph shows a slightly displaced fracture of the distal fourth metacarpal head. No other injuries are present.

The patient’s hand was left in the splint, and orthopedic evaluation was obtained.

For more information, see “Secondary Survey of Trauma Patient.” Clinician Reviews. 2015;25(12):10,35.

1. A 45-year-old construction worker accidentally fell 20 ft from a scaffolding. He is unable to flex or extend his right wrist due to pain. Examination of the wrist shows a moderate amount of soft-tissue swelling with moderate tenderness along the base of the first metacarpal.

Diagnosis: The radiograph shows an acute, comminuted fracture of the scaphoid bone. The patient was placed in a thumb spica splint and sling. He was instructed to follow up in one to two days with the hand surgeon who was on call, with anticipation of subsequent open reduction and internal fixation.

For more information, see “Construction Worker Falls From Scaffolding.” Clinician Reviews. 2013;23(11):15.

2. A 90-year-old man “just passed out” in his yard, landing in an ant nest. He experiences bilateral wrist pain, presumably from multiple ant bites. Both wrists are tender; range of motion causes tenderness. Inspection demonstrates mild to moderate circumferential swelling with several raised, reddened bumps.

Diagnosis: The radiograph shows some osteopenia and significant vascular calcifications. Of note, there is a fracture of the styloid process of the radius, extending slightly to the joint space. The patient was placed in a splint and orthopedic referral was obtained.

Wrist Pain After a Fall. Clinician Reviews. 2012;22(9):22.

3. The middorsal aspect of a 48-year-old woman’s right hand was accidentally caught in a metal door as it was being shut. Examination shows mild to moderate soft tissue swelling and some early bruising. There is extreme tenderness over the fourth and fifth metacarpal bones. Although limited by swelling, she can flex her fingers somewhat.

Diagnosis: The radiograph shows a comminuted fracture of the proximal fifth phalanx. Soft tissue swelling is noted as well. The patient’s hand was splinted, and arrangements for outpatient orthopedic follow-up were made.

For more information, see “Hand Slammed in Door.” Clinician Reviews. 2013 May;23(5):20.

4. A trauma patient arrives in your facility after a motor vehicle collision. His right hand and wrist appear to be moderately swollen, and he has been placed in a splint.

Diagnosis: The radiograph shows a slightly displaced fracture of the distal fourth metacarpal head. No other injuries are present.

The patient’s hand was left in the splint, and orthopedic evaluation was obtained.

For more information, see “Secondary Survey of Trauma Patient.” Clinician Reviews. 2015;25(12):10,35.