A Rare Fracture

​Colleague: Do think that is broken?Me: Yep.Colleague: Have you ever seen that before?Me: No. Still it is broken. How did he do that?I've been writing this blog long enough that most people I work with know I love the unusual, unexpected, and even classic radiographs. Most also know that I think emergency medicine is the best of all specialties. There is always a chance of something new, something I have never seen before. We are always learning. Thus, I was drawn in by these radiographs of a patient complaining of pain at the base of his thumb after a motor vehicle crash.Typically, the hand has re are five sesamoid bones. Two of these likely act as pulleys in the tendons at the thumb's metacarpophalangeal joint. These tiny bones may be fractured by hyperextension of the joint or direct trauma. The photos above magnify the oblique, lateral, and AP images of the base of the thumb. One can easily see the fracture line through the ulnar sesamoid bone in the oblique and lateral views. Often, as in this case, sesamoid fracture is difficult to visualize on the AP film. But look closely, and the typical encircling sclerotic line will appear incomplete. A sharp angle is also seen at the proximal end of the sesamoid bone, which is more common in fractures.Fortunately, most sesamoid fractures do well with splinting unless there is thumb instability. A few may need surgery for fragments entering the joint or excision for continued pain. Orthopedic follow-up is importan...
Source: Lions and Tigers and Bears - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs