Diagnosis: This patient has a comminuted fracture of the base of the third metacarpal (arrow) with dorsal dislocation and palmer angulation (Figure 3). Note how the third metacarpal does not line up with the second (lines).These findings reiterate the importance of looking at multiple views when reading films. The injury is barely seen on the AP view, but clearly abnormal on the lateral. CT or MRI was recommended to further delineate the injury and exclude fourth metacarpal and hamate injury.
A comminuted fracture like this one is a relatively uncommon injury in urgent care because the amount of force necessary to disrupt the MCC joints is usually only seen in motor vehicle accidents or other serious trauma. Immediate referral and repair by an experienced hand specialist is required in these cases.
Acknowledgement: Case presented by Tracey Quail Davidoff, MD, an urgent care physician at Accelcare Medical Urgent Care and Urgent Care by Lifetime Health in Rochester, NY.
