The Hand

PA

Pronation oblique

Lateral

Fractures

• Phalanges (55% of hand injuries)

  • Distal (50+% of fractures of the phalanx)

    • Ungual tuft, base, shaft, baseball finger avulsion

  • Proximal (15% of fractures of the phalanx)

    • Shaft, base, condyles, volar plate avulsion

  • Middle (10+% of fractures of the phalanx)

    • Shaft, base, condyles, volar plate avulsion

  • Metacarpals (36% of hand injuries)

    • Shaft, base, head, neck (boxer’s fracture of fourth and fifth MCs)

• Thumb

  • Base of metacarpal

    • Intraarticular – Bennett’s, Rolando’s

    • Extraarticular – transverse, oblique

  • Distal phalanx

    • Ungual tuft, base, shaft

Dislocations

• Interphalangeal joints (DIP and PIP)

• Metacarpophalangeal joints

• Carpometacarpal joints

  • Fourth and fifth CMC fracture dislocation most common

50% involve the proximal phalanx.

Majority of fractures of the phalanges and metacarpals

• a.

  involve the epiphysis

• b.

  Salter-Harris type 2, most common

High percentage best seen on the oblique view.

Fracture-dislocations of the fourth and fifth carpometacarpal (CMC) joints

Fractures of the condyles of the phalanges