Resolution
The x-ray reveals a fracture at the base of the proximal phalanx and distal radius. The proximal phalanx has some deviation.
One can do a local digital block at the base of the fifth digit and then apply mid traction to reduce the fracture. Given the fracture of the digit and distal radius, one would apply a gutter slab that wraps around to the volar aspect of the forearm and advise the parents to follow up with an orthopedist.
This case also presents an opportunity to stress the importance of careful examination and low index of suspicion when evaluating children with injuries.
Often, children do not localize pain well and cannot explain mechanism of action. Inability to use an extremity through the full range of motion should raise suspicion of bony injury to the affected limb segment.
In addition, distraction techniques can often relieve anxiety and allow for a more useful examination. Once anxiety is relieved, any derangement of function should be taken very seriously and imaged as necessary.
Acknowledgement: Case presented by Nahum Kovalski, BSc, MDCM, Terem Emergency Medical Centers, Jerusalem, Israel.
