Hand Fracture Workup

  • Author: Jon Alke, MD; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Apr 12, 2011
 

Laboratory Studies

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

In ED, plain radiography is the 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 ofPhalangeal fractures. Complex unstable fracture of the proximal phalanx. Image courtesy of Mark Baratz, MD. Displaced fourth and fifth metacarpal fractures, aDisplaced fourth and fifth metacarpal fractures, anteroposterior view. Fourth and fifth metacarpal fractures, oblique vieFourth 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.

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Procedures

  • Patients in severe pain or those who require reduction may be anesthetized by metacarpal or wrist nerve blocks.
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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  Staff Physician, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates

Disclosure: Nothing to disclose.

Specialty Editor Board

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.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Eric L Legome, MD  Chief, Department of Emergency Medicine, Kings County Hospital Center; 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.

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 

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

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.

 
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Assessment of the hand for rotational deformities of the fingers or metacarpals is essential, as such deformities, if untreated, may result in significant functional compromise. With fingers flexed at the metacarpophalangeal and proximal interphalangeal joints and extended at the distal interphalangeal joints, fingers should all point toward the scaphoid bone (see image).
Phalangeal fractures. Complex unstable fracture of the proximal phalanx. Image courtesy of Mark Baratz, MD.
Displaced fourth and fifth metacarpal fractures, anteroposterior view.
Fourth and fifth metacarpal fractures, oblique view.
Metacarpophalangeal ligaments.
Metacarpophalangeal musculoskeletal structure.
 
 
 
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