Workup
Imaging Studies
Most malunited fractures of the hand can be detected with the help of plain radiography. The three common views (ie, anteroposterior, lateral, and oblique) yield adequate information.
Computed tomography (CT) and magnetic resonance imaging (MRI) may be helpful in the assessment of complex articular injuries or carpal injuries. Three-dimensional (3D) planning based on CT data may provide useful data about the deformity, facilitate the development of patient-specific instruments, and improve the accuracy of surgical correction. [9]
In cases of carpal bone fractures, radioisotope scanning may be useful.
Media Gallery
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Examination of the patient's hand with the fingers flexed may clearly reveal a rotational deformity.
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Metacarpal shaft malunion with dorsal angulation in the same patient as in Images 3-5 in Multimedia.
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Deformity of metacarpal malunion also becomes prominent when the fingers are flexed (same patient as in Images 2, 4, and 5 in Multimedia).
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Oblique radiograph of the hand shows dorsal angulation (same patient as in Images 2, 3, and 5 in Multimedia).
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Anteroposterior radiograph of the hand does not show any clinically significant deformity in that plane (same patient as in Images 2-4 in Multimedia).
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Distal metaphyseal malunion with volar displacement of the middle phalanx in a 9-year-old boy (same patient as in Images 7 and 8 in Multimedia).
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Note the lack of clinical deformity (same patient as in Images 6 and 8 in Multimedia).
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In terms of function, the finger, including the portion at the distal interphalangeal joint, can be flexed completely as the patient makes a fist (same patient as in Images 6 and 7 in Multimedia).
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