Journal of Urgent Care Medicine

Practice Management

A 27-Year-Old Male with Swelling and Pain in His Hand After an Altercation with a Wall

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The Resolution

Differential Diagnosis

  • Bone contusion
  • Boxer’s fracture
  • Carpometacarpal dislocation
  • Intraarticular fracture
  • Metacarpal-carpal boss

Diagnosis

This patient suffered an intraarticular fracture at the base of the fifth metacarpal, with medial subluxation and foreshortening of the fracture fragment.

Learnings/What to Look for

  • This injury is less common than distal boxer’s fracture
  • Recognition of the subluxation may save the patient disability

 

Pearls for Urgent Care Management and Considerations for Transfer

  • This injury may require surgical intervention. Immobilize, provide supportive care, and refer for orthopedic follow-up
A 27-Year-Old Male with Swelling and Pain in His Hand After an Altercation with a Wall