Trauma X-ray - Upper limb
Hand/fingers

The hand comprises the metacarpal and phalangeal bones. Fractures and dislocations are usually straightforward to identify, so long as the potentially injured bone is fully visible in 2 planes.

Finger joints commonly dislocate and are susceptible to avulsion injuries.

Standard views are posterior-anterior (PA), oblique and lateral.

Finger dislocation

Finger dislocation is usually evident clinically. X-ray can be used to check for underlying bone injury and to reassess following reduction of the dislocation.

Finger shaft injuries

Some finger fractures are easy to identify, but others are more difficult to spot because of overlying bones or soft tissues.

The most common metacarpal fracture is the 'boxer's' type injury.

Intra-articular fractures

Intra-articular fractures have a worse prognosis and are often the most difficult to see. Check all views available. If a fracture is not visible and there is sufficient clinical suspicion of bone injury then a request for further views may be helpful.

Mallet finger injury

Hyperflexion of the DIP joints may result in avulsion of the distal phalanx base on the dorsal side. More commonly there is tearing of the extensor tendon which is an injury not directly visible with X-ray.

If there is a clinically evident mallet deformity, but no bone injury, do not make the mistake of thinking there is no significant injury.