SET T0051 -
Mixed Urgent Care Centre cases -
2019

There are lucencies at the proximal end of the metacarpal of the thumb. They extend to the articular surface.

There is also some slight loss of alignment of the normal carpometacarpal alignment.

These appearances represent at least a Bennett's fracture and is therefore unstable. K-wire fixation may well be necessary.

There is an oblique lucency on the lateral projection representing a fracture.

A distal fibula fracture is a more common injury. However this is a tibial fracture and therefore a more significant injury.

There are a number of features that can help us identify this as tibial rather than fibular fracture.

1. The lucency stops at the physis at the distal end.

2. It does not extend to the fibular cortex proximally.

3. There is some widening of the anterior tibial physis.

4. Loss of alignment of the anterior tibial metaphysis with the anterior tibial epiphysis. The posterior aspects remain aligned.

Summary: Salter Harris II distal tibial fracture.

Normal radiographs.

The fat pads are not obviously raised.

There is some slight medial displacement of the medial epicondyle. There is some slight overlying soft tissue swelling.

Normally this sits closer to the humeral condyle and is often tucked in behind it.

This is an avulsion fracture of the medial epicondyle. Surgical management is a consideration.