finger & thumb pathology & image analysis

What type of fracture is shown in the image?

Tuft or burst fracture

What type of fracture is “a fracture of the fine cancellous bone at the distal tip of the phalanx”?

Tuft or burst fracture

What is a “tuft or burst fracture”?

a fracture of the fine cancellous bone at the distal tip of the phalanx

What are the causes of a tuft or burst fracture?

direct blow or a crush injury, lacerations, hyperextension, hyperflexion, rotation

What are the complications of a tuft or burst fracture?

Rare, but can have joint stiffness, numbness and hypersensitivity, and nail deformities

What is the radiographic appearance of a tuft or burst fracture?

comminuted fractures of the distal phalanx

What are the technical factor considerations of a tuft or burst fracture?

Neither additive or subtractive. No technical factor change.

What is the prognosis/treatment of a tuft or burst fracture?

Ice and splinted

What fracture does the image show?

tuft or burst fracture

What type of fracture is shown in the image?

Baseball (Mallet) fracture

What is a Baseball (Mallet) fracture?

Injury to the thin tendon that straightens the end joint of a finger or thumb

What type of fracture is “Injury to the thin tendon that straightens the end joint of a finger or thumb”?

Baseball (Mallet) fracture

What are the causes of Baseball (Mallet) fracture?

unyielding object (like a ball) strikes the tip of a finger or thumb and forces it to bend further than it is intended to go

What is the complication of a baseball (mallet) fracture?

Infection

What type of fracture is shown in the image?

Baseball (Mallet) fracture

What is the radiographic appearance of a Baseball (Mallet) fracture?

a piece of the distal phalanx bone breaks away with the tendon

What is the technique for a Baseball (Mallet) fracture?

No manual exposure factor change

What is the Prognosis/Treatment for a Baseball (Mallet) fracture?

Splint or Surgical repair for larger fracture

What fracture is shown in the image?

Baseball (Mallet) fracture

What fracture is shown in the image?

Baseball (Mallet) fracture

What fracture is shown in the image?

Bennett’s fracture

What is a Bennett’s fracture?

Fracture of the base of the thumb

What is a “Fracture of the base of the thumb” called?

Bennett’s fracture

What is the cause of a Bennett’s fracture?

forced abduction of the first metacarpal

What is a complication of a Bennett’s fracture?

Osteoarthritis

What is the radiographic appearance of a Bennett’s fracture?

two-piece fracture of the base of the thumb metacarpal

What is the technical factor consideration of a Bennett’s fracture?

Neither additive or subtractive. No technical factor change.

What is the prognosis/treatment of a Bennett’s fracture?

Spica cast or surgery

What type of fracture is shown in the image?

Bennett’s fracture

What type of fracture is shown in the image?

Bennett’s fracture

What are the acceptable EI values for fingers?

100-300

What projection is this finger x-ray?

PA

What deems a PA finger x-ray acceptable?

• side marker placed clear of anatomy of interest

• Entire digit from fingertip to distal portion of the adjoining metacarpal

• No soft tissue overlap from adjacent digits

• No rotation

• Equal concavity of both sides of the phalangeal bodies

• Equal amount of soft tissue on both sides of the phalanges

• Fingernail, if seen, centered over the distal phalanx

• Open interphalangeal (IP) and MCP joint spaces

• Bony trabecular detail and surrounding soft tissues

What deems an oblique finger x-ray acceptable?

• side marker placed clear of anatomy of interest

• Entire digit, including the distal portion of the adjoining metacarpal

• Digit rotated at a 45-degrees, demonstrated by the concavity of the elevated side of the phalangeal bodies

• No superimposition of the proximal phalanx or MCP joint by adjacent digits

• Open interphalangeal (IP) an MCP joint spaces

• Bony trabecular detail and surrounding soft tissues

What projection is this finger x-ray?

Oblique

What projection is this finger x-ray?

Lateral

What deems a lateral finger x-ray acceptable?

• side marker placed clear of anatomy of interest

• Entire digit from fingertip to distal portion of the adjoining metacarpal

• No rotation:

• Fingernail in profile, if visualized and normal

• Concave, anterior surfaces of the phalanges

• No superimposition of the proximal phalanx or MCP joint by adjacent digits

• Open interphalangeal (IP) joint spaces

• Bony trabecular detail and surrounding soft tissues

Which x-ray projection + structure is shown?

Thumb oblique

What deems an oblique thumb x-ray acceptable?

• side marker placed clear of anatomy of interest

• Area from the distal tip of the thumb to the trapezium

• Proper rotation demonstrated by concave surface of elevated side of the proximal phalanx and metacarpal

• Open interphalangeal (IP) and MCP joint spaces

• Bony trabecular detail and surrounding soft tissues

Which x-ray projection + structure is shown?

Thumb - Lateral

What deems a lateral thumb x-ray acceptable?

• side marker placed clear of anatomy of interest

• Area from the distal tip of the thumb to the trapezium

• No rotation:

• Concave anterior surface of the proximal phalanx and metacarpal

• Thumbnail, if visualized and normal, in profile

• Open interphalangeal (IP) and MCP joint spaces

• Bony trabecular detail and surrounding soft tissues

Which x-ray projection + structure is shown?

Thumb - AP

What deems a AP thumb x-ray acceptable?

• side marker placed clear of anatomy of interest

• Area from the distal tip of the thumb to the trapezium

• No rotation:

• Concavity of the phalangeal and metacarpal bodies

• Equal amount of soft tissue on both sides of the phalanges

• Thumbnail, if visualized, in the center of the distal thumb

• Overlap of soft tissue profile of the palm over the midshaft of the first metacarpal

• Open interphalangeal (IP) and MCP joint spaces without overlap of bones

• Bony trabecular detail and surrounding soft tissues