Radiology Review

Hand Pain Following an Altercation

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A 60-year-old man presents with a complaint of pain in his right fifth finger following an altercation. He is not sure exactly how the injury occurred, but he does recall that at one point his hand was twisted awkwardly. He denies any significant medical history. His vital signs are normal. Primary survey appears normal as well. On examination, you notice moderate swelling around the fifth finger of his right hand, which does appear to be slightly deformed. There are no obvious wounds or lacerations. He has moderate tenderness at the base of his finger. Range of motion is limited due to the swelling. Good capillary refill time is noted. The triage nurse already sent the patient for a radiograph of his finger (shown). What is your impression?


 

ANSWER

The radiograph shows moderate soft-tissue swelling with dislocation of the proximal interphalangeal joint. No definite fracture is seen. In addition, there are some metallic-appearing foreign bodies.

The patient was treated with closed ­reduction and splinting. He also received a referral to outpatient orthopedics for ­follow-up.

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