Imaging Studies
In the ED, plain radiography is the diagnostic test of choice to evaluate potential hand fractures. [8] Standard radiographs include AP, lateral, and oblique views. Special imaging studies, such as MRI, CT, and bone scans, are seldom needed in the ED to evaluate hand injuries. However, hook of hamate fractures are difficult to identify on plain radiographs because the base of the hamate is not well visualized. When such fractures are suspected, CT is the imaging modality of choice. It shows the complete hamate bone and is also useful for excluding other bone injuries or congenital anomalies. MRI may provide information regarding injury to the surrounding soft tissue and vascularity of the hamulus. [13]
(See the radiographic images below.)
Phalangeal fractures. Complex unstable fracture of the proximal phalanx. Image courtesy of Mark Baratz, MD.
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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).
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Phalangeal fractures. Complex unstable fracture of the proximal phalanx. Image courtesy of Mark Baratz, MD.
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Displaced fourth and fifth metacarpal fractures, anteroposterior view.
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Fourth and fifth metacarpal fractures, oblique view.
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Metacarpophalangeal ligaments.
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Metacarpophalangeal musculoskeletal structure.
