Hand Projections
- multiple fingers?
- single finger?
multiple phalanges or metacarpals: PA and oblique
thumb or single digit: PA and lateral of only affected digit
Fingers
ligaments and their associated avulsion #’s
Extensor ligament: dorsal aspect of phalanx: can result in dorsal avulsion #
Collateral ligaments: lateral/medial aspect of phalanx = lateral/medial avulsion #
Volar Plate: palmar aspect of phalanx
Carpometacarpal joint spaces are equal in width: 1-2mm
Finger #s
when should orthopaedic assessment be required?
Orthopaedic assessment is required if:
- articular surface is involved
- avulsion of a fragment
- flexion deformity (mallet finger)= almost impossible to happen without ligament injury
NAME THE PATHOLOGY # of the neck of 5th metacarpal
Boxer’s fracture
NAME THE PATHOLOGY
Intra-articular, oblique # at base of 1st metacarpal with associated dislocation of the 1st carpometacarpal joint
Bennett’s fracture
The large fragment is pulled dorsally and radially by the abductor pollicis longus
THIS IS AN UNSTABLE INJURY AND REQUIRE OPEN REDUCTION
NAME THE PATHOLOGY
comminuted, intra-articular # at base of 1st metacarpal
Rolando’s #
very unstable
Y, V. or T fragment configuration
Dislocations
- (most commonly affected metacarpals?)
- (there is a # of the dorsal aspet of the hamate, what do you need to consider?)
- (what is not present between base of metacarpal and articular surface of carpal if the joint is dislocated?))
4th and 5th metacarpals are most commonly affected by dislocations
Associated with a # at the base of the affected, or adjacent, metacarpal
Consider the possibility of a dislocation of 5th carpometacarpal joint if there is a # of the dorsal aspect of the hamate
A lack of parrallelism between a metacarpal and the associated carpal suggests a dislocation
NAME THE PATHOLOGY
- ruptrue or stretching of the ulnar collateral ligament at the 1st metacarpophalangeal joint
Gamekeeper’s/skier’s thumb
PA Hand Positioning
- Arm abducted, elbow flexed 90 deg, Palm of hand on detecctor
- ideally shoulder, elbow and wrist all in the same plane
- centre on head of 3rd metacarpal
- collimate to include all of distal phlanges, the radioulnar joint, lateral skin margins
- 52kVp 2mAs
Oblique Hand positioning
- From PA position, hand is externally rotated 45 deg
- centre head of 3rd metacarpal
- collimate to include whole hand and radioulnar joint
- 52kVp 2mAs
Lateral Hand positioning
- Hand is externally rotaed from PA position 90 deg (palm is perpendicular to the detector)
- fingers parallel, thumb abducted
- centre over head of 2nd metacarpal
- collimate to include distal aspect of phalanges, dorsal and palmar skin margins, and include radioulnar joint
- 55kVp 3mAs
