Man with bruised hand

These x-rays were taken on a 47-year-old male who presented to an urgent care clinic 3 days after punching a wall. He had pain, massive swelling, and bruising at the base of the 3rd, 4th and 5th metacarpals of the right hand.
View the images taken (Figure 1) and consider what your diagnosis would be.

Tracey Quail Davidoff, MD

Urgent care physician, BayCare Urgent Care, Florida. Editorial Board Member, the Journal of Urgent Care Medicine