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Resolution
The patient has a fracture at the base of the metacarpal. The decreased range of motion is probably most attributable to pain, as opposed to being indicative of the severity of the injury.
It was important to note the lack of snuffbox tenderness in this patient. Snuffbox tenderness is highly suggestive of scaphoid fracture, especially among patients who experienced a fall like this patient did. Hence, its absence may alleviate clinical suspicion of that particular injury and help guide the clinician to the true injury site.
The patient was casted by the orthopedist and signed out.
Acknowledgment: X-rays taken and fractures identified by radiologist Scott Fields, MD. Case presented by Nahum Kovalski, BSc, MDCM.
Clinical Challenge 2: March, 2007
Nahum Kovalski, BSc, MDCM
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