HSS What's the Diagnosis Case #119

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What’s the Diagnosis – Case 119

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What’s the Diagnosis – Case 119

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What’s the Diagnosis – Case 119

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What’s the Diagnosis – Case 119

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What’s the Diagnosis – Case 119

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Findings Not typically the thrust of these cases, this is more so of an “eye test”. On the radiographs there is a loss of the space at the 4th and 5th CMC articulations. On the subsequent CT images and reformations the 4th and 5th CMC fracture dislocations become much more obvious. The other concept is the necessity of at least two views at 90 degrees or orthogonal to one another to allow adequate examination.

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Diagnosis: 4th/5th Carpometacarpa Fracture Dislocation The most common of the CMC fracture dislocations involve the small and then ring fingers. These articulations are more mobile than the remainder of the articulations and particularly the pull of the ECU attachment at the base of the fifth metacarpal makes these locations most susceptible to injury. Invariably there is dorsal displacement of the metacarpals. There is typically impacted fracturing along the dorsum of the hamate and at times as in this case along the dorsum of the capitate. As was mentioned previously, on the CT examination this is not a diagnostic dilemma. However, this case again underscores the necessity for at the least orthogonal radiographs for adequate assessment. In addition, this shows how radiographs at times can underestimate/belie the overall extent of injury. Well delineated is the importance of understanding typical presentations of pathology and the need for further imaging for confirmation and as in this case, preoperative planning.

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