Imaging Case of the Week 488 Answer

The left wrist x-ray shows

an intra-articular two part fracture of the base of the 5th metacarpal & scaphoid waist fracture. The pattern of injury to the base of 5th metacarpal is called the ‘reverse Bennett’s fracture’ and is analogous to the Bennett’s fracture of the base of the thumb metacarpal.

Reverse Bennett’s fracture is an unstable injury. The pull from extensor carpi ulnaris tendon which inserts into the base of the 5th metacarpal, acts as a deforming force and as such this injury needs referral to a hand surgeon for consideration of operative management.