PEM Source

Your source for all things Pediatric Emergency Medicine


Question: Ortho

(Click the link to comment and to vote – voting not working through email, sorry!)

You are seeing a 17 year old boy who fell while skateboarding and sustained an axial loading force to his right thumb. He is exquisitely tender at the base of the thumb (carpometacarpal joint), and you note swelling as well. Which of the following injuries is least likely to be encountered based on this mechanism and exam?

Which of the following injuries is least likely to be encountered in this patient?

pemsou5_wp • November 9, 2021

Previous Post

Next Post


  1. Kelly November 14, 2021 - 6:13 pm Reply

    A) Gamekeeper’s thumb
    An axial loading force on the thumb in flexion can produce base of the thumb metacarpal fractures such as the Bennett fracture, a partially intra-articular fracture on the ulnar side, or the Rolando fracture, a completely intra-articular, often comminuted / T or Y-shaped fracture at the base of the thumb. An axial loading or hyperextension force on the adducted thumb can rarely produce a trapezium fracture. All three of these present with findings at the base of the thumb, or the carpometacarpal (CMC) joint. Gamekeeper’s thumb (aka skier’s thumb) results from forced abduction/hyperextension of metacarpophalangeal (MCP) joint, injuring the ulnar collateral ligament +/- causing an avulsion fracture of the base of the proximal phalanx. These patients have tenderness on the ulnar side of MCP joint, rather than the CMC joint.

Leave a Reply

Your email address will not be published / Required fields are marked *