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Forum Name: Bone trauma and fractures

Question: Is it fractured?


 downsbs - Thu Aug 04, 2005 10:10 am

Okay I was in a fight, missed and punch a steel door about six weeks ago. I still cannot put any pressure on my wrist, I tried doing some dips earlier and could not support my own body weight without great pain. What do you guys think? Thank you in advance
 Dr. A. Saif - Fri Aug 05, 2005 5:23 pm

User avatar Hullo there, Downsbs,

Sorry to hear about you plight, hope that the steel door is ok ;-). It is impossible to say from your description whether there is a bony injury or not for definite. It is certainly very difficult to determine this without examining you clinically. You have some pain at a time by which most injuries will have healed, but you do suggest you get this with reasonably strenuous activity.

It is not uncommon to break something with a punch. Usualy it is the 5th Metacarpal, the bone in your hand that is connected to your pinky, but other injuries are possible. Most (but not all) boy injuries heal by about 4-6 weeks. You describe the pain being in your wrist rather than your hand. the location is important, as is the triggering factor for the pain.

BONY INJURIES
Pain at the part of your wrist near the base of your thumb metacarpal (the bone in your hand connected to your thumb, can be associated with injuries to the scaphoid, or radial styloid. Both may take some time to heal, and sometimes do not heal. If there is is tenderness in the the little pit at the back of your hand near the thumb (called the "anatomical snuffbox") it suggests that one of these injuries are possible, and one should be investigated for this.
If the pain is more toward the "ulnar" side of the hand (the side of the hand one might give a karate chop with), then a punching action may cause a fracture of the 5th metacarpal. seeing as you describe the pain being at your wrist, the possiblitility of fracturing this at the base exists. You may notice a discrepancy in the shape of your hand, even after 6 weeks, and a prominence and pain here at this late stage may possibly indicate a fracture.
A fracture of the radius can occur, but usually this is so painful that you attend the ER early. These usually heal well by six weeks. A type of fracture that is sometimes missed, the die punch fracture, where only a small part of the end of the radius is broken, as it usually involves the joint surface, you may get pain even if the fracture unites.
Minor bony injuris can occur elsewherein the wrist...but tese hopefully will cover most possibilities.

SOFT TISSUE INJURIES
These are also common. the pain seemes to be often more diffuse, and difficult tonpin point. Pain is usually aggravate by pulling or stretching, as opposed to bony injuries where compression increases pain. Unusual causes of sustained pain are damage to to the triangular fibrocartilage...soemtimes associated with a clicking in your wrsit with twisting maneouvres.

The possibilities are endless...the way I would manage this in your case (6 weeks from the injury) is be guided by the overall trend rather than disocomfort at a particular point. if things are not improving then seek clinical advice; that isbthe only way to really distinguish the various possibilities...even then things are not always clear cut....

Regards

Saif

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