eMedicine Specialties > Emergency Medicine > Trauma & Orthopedics

Fracture, Hand: Differential Diagnoses & Workup

Author: Jon Alke, MD, Staff Physician, Stanford/Kaiser Emergency Medicine Residency, Stanford University School of Medicine
Coauthor(s): Erik D Schraga, MD, Consulting Staff, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates; Consulting Staff, Permanente Medical Group, Kaiser Permanente, Santa Clara Medical Center
Contributor Information and Disclosures

Updated: Dec 10, 2009

Differential Diagnoses

Dislocations, Hand
Dislocations, Wrist
Hand Infections
Hand Injury, Soft Tissue

Workup

Laboratory Studies

  • Lab studies are not indicated in the workup of acute fractures. 

Imaging Studies

  • In ED, plain radiography is diagnostic test of choice to evaluate potential hand fractures.1
  • Standard radiographs include AP, lateral, and oblique views. Example radiographs are shown below.

    • Phalangeal fractures. Complex unstable fracture o...

      Phalangeal fractures. Complex unstable fracture of the proximal phalanx. Image courtesy of Mark Baratz, MD.

      Phalangeal fractures. Complex unstable fracture o...

      Phalangeal fractures. Complex unstable fracture of the proximal phalanx. Image courtesy of Mark Baratz, MD.


    • Displaced fourth and fifth metacarpal fractures, ...

      Displaced fourth and fifth metacarpal fractures, anteroposterior view.

      Displaced fourth and fifth metacarpal fractures, ...

      Displaced fourth and fifth metacarpal fractures, anteroposterior view.


    • Fourth and fifth metacarpal fractures, oblique vi...

      Fourth and fifth metacarpal fractures, oblique view.

      Fourth and fifth metacarpal fractures, oblique vi...

      Fourth and fifth metacarpal fractures, oblique view.

  • Special imaging studies, such as MRI, CT, and bone scans, seldom are needed in ED to evaluate hand injuries.

Procedures

  • Patients in severe pain or those who require reduction may be anesthetized by metacarpal or wrist nerve blocks.

More on Fracture, Hand

Overview: Fracture, Hand
Differential Diagnoses & Workup: Fracture, Hand
Treatment & Medication: Fracture, Hand
Follow-up: Fracture, Hand
Multimedia: Fracture, Hand
References

References

  1. [Guideline] Rubin DA, Daffner RH, Weissman BN, Bennett DL, Blebea JS, Jacobson JA, et al. ACR Appropriateness Criteria acute hand and wrist trauma. [online publication]. Reston (VA): American College of Radiology (ACR). 2008;[Full Text].

  2. Oetgen ME, Dodds SD. Non-operative treatment of common finger injuries. Curr Rev Musculoskelet Med. Jun 2008;1(2):97-102. [Medline].

  3. Henry MH. Fractures of the proximal phalanx and metacarpals in the hand: preferred methods of stabilization. J Am Acad Orthop Surg. Oct 2008;16(10):586-95. [Medline].

  4. American Society for Surgery of the Hand, Idler RS, Mantktelow RT. The Hand Examination and Diagnosis. New York: Churchill Livingstone; 1990:13-73.

  5. Emergency Medicine: Concepts and Clinical Practice [book on CD-ROM]. Mosby-Year Book; 1998. Antosia R, Lyn E.

  6. Harwood-Nuss A, Wolfson A. Hand injuries. In: Clinical Practice of Emergency Medicine. 4th ed. 2005:1062-1065.

  7. Rosen P, Doris P. Musculoskeletal trauma. In: Diagnostic Radiology in Emergency Medicine. 1992:178-182.

  8. Ruiz E, Cicero JJ. Hand injuries and infections. In: Emergency Management of Skeletal Injuries. St. Louis, MO: Mosby-Year Book; 1990:339-59.

  9. Simon RR, Koenigsknecht SJ. Fractures of the hand. In: Emergency Orthopedics. 4th ed. New York: McGraw-Hill; 2001:97-133.

  10. Stewart C, Winograd S. Hand injuries: a step by step approach for clinical evaluation and definitive management. Emerg Med Rep. 1997;18:223-234.

  11. Tintinalli JE, Ruiz E, Krome RL. Injuries to the hand and digits. In: Emergency Medicine: A Comprehensive Study Guide. 2004. 6th ed. New York: McGraw Hill; 2004:1665-1674.

Further Reading

Keywords

hand fracture, broken hand, hand injury, fractures of the phalanges, volar fracture dislocation, middle phalanx fractures, transverse fracture of distal phalanx, middle phalangeal fractures, proximal phalangeal fractures, transverse fracture of the proximal phalanx, oblique fractures, spiral fractures, condylar fractures, metacarpal fractures, metacarpal head fractures, metacarpal neck fractures, metacarpal shaft fractures, metacarpal base fractures, Bennett fractures, Rolando fractures

Contributor Information and Disclosures

Author

Jon Alke, MD, Staff Physician, Stanford/Kaiser Emergency Medicine Residency, Stanford University School of Medicine
Jon Alke, MD is a member of the following medical societies: American College of Emergency Physicians and Emergency Medicine Residents Association
Disclosure: Nothing to disclose.

Coauthor(s)

Erik D Schraga, MD, Consulting Staff, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates; Consulting Staff, Permanente Medical Group, Kaiser Permanente, Santa Clara Medical Center
Disclosure: Nothing to disclose.

Medical Editor

Francis Counselman, MD, Program Director, Chair, Professor, Department of Emergency Medicine, Eastern Virginia Medical School
Francis Counselman, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, Association of Academic Chairs of Emergency Medicine (AACEM), Norfolk Academy of Medicine, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Eric L Legome, MD, Chair, Department of Emergency Medicine, St Vincent's Hospital Manhattan; Associate Professor, Department of Emergency Medicine, New York Medical College
Eric L Legome, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, Council of Emergency Medicine Residency Directors, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: WebMD Salary Employment

 
 
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