Clinical Review ABC of emergency radiology

Hand

BMJ 2005; 330 doi: http://dx.doi.org/10.1136/bmj.330.7499.1073 (Published 05 May 2005) Cite this as: BMJ 2005;330:1073
  1. Otto Chan,
  2. Tudor Hughes

    Introduction

    The hand is exposed and at risk of injury. It is therefore not surprising that hand injuries are the commonest skeletal injuries, and they account for 10-20% of attendances at accident and emergency departments. Fractures of the phalanges are more common than fractures of the metacarpals. Fractures of the distal phalanx account for half of all phalangeal fractures. Metacarpal injuries occur most commonly in the thumb and little finger.

    Dorsal (left) and lateral (right) view of left index finger

    Most injuries of the hands are easy to detect and correlate well with clinical findings. Identification of injuries is essential because early detection and appropriate management usually leads to recovery of normal function. Conversely, delay in diagnosis of what seems to be a minor abnormality can lead to a severe disability. Surgery is rarely necessary and only indicated for specific injuries. Clinical examination determines which radiographic views should be obtained.


    Embedded Image

    Anteroposterior (left) and lateral (middle left) view of thumb. Anteroposterior (middle right) and lateral (right) view of finger


    Embedded Image

    Embedded Image

    Embedded Image

    Anatomy

    Each finger consists of one metacarpal and three phalanges, and the thumb consists of one metacarpal and two phalanges. Each bone has a head, a shaft, and a base. Strong ulnar and radial collateral ligaments prevent sideways movement of the joints. The joint capsule of the interphalangeal and metacarpophalangeal joints is thickened on the palmar (volar) aspect and forms a dense fibrous structure (volar plate). This attaches to the base of the phalanx. Each finger has two flexor tendons and one extensor tendon. Sesamoid bones may be found on the palmar aspect …

    View Full Text

    Sign in

    Log in through your institution

    Free trial

    Register for a free trial to thebmj.com to receive unlimited access to all content on thebmj.com for 14 days.
    Sign up for a free trial

    Subscribe