This is one of the most painful X-rays of my career and it is older than 30 years. The exact history eludes me but there has been obvious traumatic injury to the handwith multiple fractures (black arrows) a transverse skin incision that contains a broad band of air (white arrow), probable debridement of the severely injured metacarpal row, and extensive pinning and wiring of the thumb following surgical trauma. The combination of the large somatic sensory nociceptor supply to the hand, together with the extensive skin, bone,and tissue damage, is difficult to perceive the extent of the pain that this poor patient went through. The remarkable feature is the maintenace of blood supply to the hand.
Courtesy Ashley DAvidoff MD copyright 2008 17496c02.8s