Emergency Medicine

Orthopaedic Emergencies 295

INJURIES TO THE WRIST AND HAND

2 There is loca lized tenderness from direct trauma, sometimes with an associ-
ated ulnar nerve palsy affecting the deep branch that supplies most of the
intrinsic hand muscles.

3 A common problem on X-ray is to remember the names of the eight carpal
bones.
(i) Try remembering that the ‘trapezium is at the base of the thumb’
and then use the mnemonic: ‘Hamlet came to town shouting
loudly to Polonius’, which refers to the hamate, capitate,
trapezoid, trapezium, scaphoid, lunate, triquetral and pisiform
bones (Fig. 9.4).

MANAGEMENT

1 Place all these fractures in a scaphoid plaster and refer to the next fracture
clinic.

Fractures of the thumb metacarpal

DIAGNOSIS

1 Injury usually results from forced thumb abduction, causing localized pain
and tenderness.

2 Always X-ray to distinguish a stable from an unstable injury.

Figure 9.4 The two rows of carpal bones
(1) hamate, (2) capitate, (3) trapezoid, (4) trapezium, (5) scaphoid, (6) lunate, (7) triquetral,
(8) pisiform.

1 2 3

4

5

6

7

8