Hand Case 1 History/Physical Exam

The mechanism is a direct impaction force, commonly of a closed fist striking a hard object. The metacarpal head rotates volarly, resulting in hyperextension of the MCP joint and dorsal angulation at the fracture line.

Physical exam findings include point tenderness, dorsal hand deformity and swelling and occasional laceration over the MCP joint (fight bite). The degree of rotation should be assessed by having the patient make a fist – all of the fingers should point to the scaphoid without overlap or "scissoring" of fingers.