A 43-year-old patient in Rochester, MN, presented to Mayo Clinic’s Ceylan Colak, MD, with complex hand trauma following a snowblower accident. While multiple phalangeal fractures were immediately apparent, as Dr. Colak recounted during the ARRS Online Course Imaging of Small Joints: A Review for Clinical Practice, a comminuted thumb fracture was initially overlooked due to the severity of the patient’s way more overt injuries.
Distal Distraction: Distal phalangeal and tuft fractures are not just common; they account for nearly 50% of all hand fractures. In the setting of high-energy trauma—vis-à-vis a southeastern Minnesota snowblower injury—rads can easily fall victim to “satisfaction of search,” missing these small yet clinically significant injuries.
Case Breakdown:
- Mechanism: Severe hand trauma caused by a snowblower.
- Initial Findings: Multiple displaced and non-displaced phalangeal fractures.
- The Miss: A comminuted, minimally displaced fracture of the thumb distal phalanx.
- Management: The patient ultimately required K-wire placement for stabilization of the multiple hand fractures.
Bottom Line: When assessing a bad hand fracture, always perform a systematic check of every digit. Don’t let the most dramatic injuries distract you from the tuft; it’s where half of all hand fractures occur.
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