radER 3.1

rader new

Case

A 33-year-old man presents to the ED complaining of left thumb pain after he fell from his horse during a polo match.  There is swelling and tenderness at the base of the thumb.  You think the patient may have sustained a fracture of his proximal thumb so you order radiographs.  One of the radiographs is seen below:

thumb1

Questions

1. What is the eponym for this fracture?

2. Which tendon is responsible for displacement of the thumb?

3. What is the ED management for this fracture?

Please click on the “comments” link or post your answer in the “reply box”. You will not see your answer post until next week when all of the submitted answers will be posted. Good luck!

radER is a weekly contest consisting of a radiograph selected from various areas of emergency medicine that are central to the education of medical students and residents in training.

15 Responses

  1. 1. Bennett’s Fracture
    2. abductor pollicus longus
    3. thumb spica splint

  2. 1. Bennetts Fracture
    2. Abductor pollicis longus
    3. Closed reduction and thumb spica cast. If closed reduction is unsuccessful then may try closed reduction with percutaneous pinning.

  3. 1. Gamekeeper’s thumb
    2. Ulnar collateral ligament
    3. Thumb spica splint, NSAIDs for swelling and pain, and follow up with orthopedics

  4. It looks like a Gamekeeper’s thumb or Stener Lesion, but since only one view is available – i’m not 100% sure which direction (volar I am assuming) it has displaced.

    it involves damage to the ulnar collateral ligament.

    a thumb spica should be fine for most injuries but if a complete tear of the UCL or avaulsion fracture of volar plate – they will need surgical treatment for repair – but that can be done as an outpt.

  5. 1) Gamekeeper’s thumb
    2) Ulnar collateral ligament
    3) Thumb spica splint

  6. 1. bennett’s fracture

    2. abductor pollicis longus

    3. thumb spica splint F/U with hand surgery for ORIF

  7. 1) Bennett’s Fx
    2) abductor pollicis longus and adductor pollicis
    3) Closed reduction and thumb spica cast immobilization in ‘hitchhiker position’

  8. 1. Bennett Fracture
    2. Abductor pollicis longus
    3. Thumb spica and hand/ortho surgery consult
    4. They play polo in Detroit?

  9. 1) Skier’s/Gamekeeper’s thumb.
    2) Ulnar collateral ligament.
    3) Need to rest thumb and ligament–place in thumb cast or wrist splint. If ligament is torn, may require surgical intervention.

  10. Bennet’s Fracture, the Abductor policis longus, immobilization with spica spint and orthopeadic referal because fracture may require surgery to reduce

  11. 1.) Bennett’s fracture

    2.) The anterior (volar) oblique ligament

    3.) Closed reduction and thumb spica cast immobilization. If it is open or reduction is unsuccessful, then patient will need surgery with pinning.

  12. 1. Bennett’s fracture
    2. the abductor pollicis longus causes lateral retraction of the 1st metacarpal shaft.
    3. Here all we have to do is call ortho, but if you had no backup I would:
    1. give appropriate analgesia
    2. do a closed reduction via thumb traction with metacarpal extension, pronation and abduction. Use the C-arm to verify careful alignment.
    3. place in thumb spica and get post reduction films.
    4. send to ortho within 3 days b/c the pt needs surgery, they’ll probably place 2 percutaneous K-wires

  13. 1. Bennett’s Fracture Dislocation. It is an oblique intra-articular fracture at the base of the 1st carpometacarpal joint.

    2. The volar fragment of the 1st proximal metacarpal (the palmar break fragment) remains articulated with the trapezius bone because it is still anchored by the anterior oblique ligament.

    The distal metacarpal fragment (the rest of the 1st metacarpal) is displaced proximally, radially, dorsally and rotated in supination by the Abductor Pollicus Longus tendon which inserts on the radial side of the 1st metacarpal.

    3. Attempt closed reduction or percutaneous pin fixation when there is less than 3mm of displacement.

    Reduce the fracture by appying inline traction to the metacarpal shaft and rotating it in pronation to bring it into opposition with the non-displaced fragment. Place in a thumb spica splint for 4-6 weeks.

    Consider open reduction and internal fixation when there is more than 3mm of displacement.

  14. […] 3. Is the prognosis better or worse than the fracture seen in radER 3.1 […]

  15. […] 3. Is the prognosis better or worse than the fracture seen in radER 3.1 […]

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