Hand

Question 1

Hand Projections

• multiple fingers?
• single finger?

Answer 1

multiple phalanges or metacarpals: PA and oblique

thumb or single digit: PA and lateral of only affected digit

Question 2

Fingers

ligaments and their associated avulsion #’s

Answer 2

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

Question 3

Finger #s

when should orthopaedic assessment be required?

Answer 3

Orthopaedic assessment is required if:

• articular surface is involved
• avulsion of a fragment
• flexion deformity (mallet finger)= almost impossible to happen without ligament injury

Question 4

NAME THE PATHOLOGY
# of the neck of 5th metacarpal

Answer 4

Boxer’s fracture

Question 5

NAME THE PATHOLOGY

Intra-articular, oblique # at base of 1st metacarpal with associated dislocation of the 1st carpometacarpal joint

Answer 5

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

Question 6

NAME THE PATHOLOGY

comminuted, intra-articular # at base of 1st metacarpal

Answer 6

Rolando’s #
very unstable
Y, V. or T fragment configuration

Question 7

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?))

Answer 7

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

Question 8

NAME THE PATHOLOGY

- ruptrue or stretching of the ulnar collateral ligament at the 1st metacarpophalangeal joint

Answer 8

Gamekeeper’s/skier’s thumb

Question 9

PA Hand Positioning

Answer 9

• 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

Question 10

Oblique Hand positioning

Answer 10

• From PA position, hand is externally rotated 45 deg
• centre head of 3rd metacarpal
• collimate to include whole hand and radioulnar joint
• 52kVp 2mAs

Question 11

Lateral Hand positioning

Answer 11

• 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