Another reason not to punch things…

June 22, 2013

Orthopedics, Trauma, Wrist XR, XR

A patient came in the other day after punching a wall.  He had an injury pattern I had never seen before:


These PA and Lateral images of the hand show dorsal dislocation of the index and middle metacarpals at the carpometacarpal joint.  You can see the proximal ends of the index and middle metacarpals posterior to the trapezium, trapezoid, and capitate bones (in order from the base of the thumb toward the ulnar side of the wrist).  This is a very rare injury and may need operative fixation (1).

Image Contributor:  Aaron Bair, MD

Author:  Russell Jones, MD


1.  Carpometacarpal fracture dislocation.  Wheeless’ Textbook of Orthopaedics.  Accessed 6/12/13.


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EMREMS: Radiology in Emergency Medicine

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