Volume 1, Case
14
A Hand Contusion
Radiology Cases in Pediatric Emergency Medicine
Volume 1, Case 14
Alson S. Inaba, MD
Rodney B. Boychuk, MD
A 17 year old male presents
to the ED with right wrist and hand pain two hours after falling on his
out-stretched (extended) right hand. The patient was jogging along the
sidewalk when he lost his balance, tripped on the curb and broke his fall
by landing on his out-stretched right hand. There was no loss of consciousness
and the only area of pain was his right wrist.
Exam: Except for some very
superficial palmar abrasions, there were no other visible signs of external
trauma over the entire right upper extremity from the clavicle to the
tips of the fingers. The shoulder and elbow both demonstrated full range
of motion without any pain. His fingers were all pink with intact neurovascular
integrity. Upon closer examination of the wrist, the patient complained
of point tenderness in the floor of the anatomic snuff box. This point
tenderness was exacerbated with wrist flexion, extension and radial deviation.
Because of point tenderness in this area, radiographs were obtained to
rule out a fracture.
View wrist radiographs.
AP
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here for a better picture
Oblique
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here for a better picture
The lateral view of the wrist
was not contributory so it is not included here. A scaphoid view was also
taken because of the area of tenderness over the scaphoid.
View scaphoid radiograph.
Scaphoid
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here for a better picture
Questions:
- What is the significance
of point tenderness in the area of the scaphoid (navicular) bone?
- How would you interpret
the radiographs shown above?
- What are the complications
of this type of injury?
- How should these types
of injuries be managed in the ED and when should you consult an orthopedic
surgeon?
What is your Diagnosis?
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here for Case 14 Answers
Loren Yamamoto,
MD, MPH Associate Professor of Pediatrics University of Hawaii John A. Burns
School of Medicine loreny@hawaii.edu
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