I’m Not As Dumb As I Look
Posted by WhiteCoat on December 12, 2007
Don’t micturate on my gastrocnemius and then try to convince me that it is due to excess precipitation.
We’ve had a run on people who are “falling” and hurting their hands lately. I haven’t felt any seismic activity, so I’m beginning to wonder what’s going on. The patients are usually younger males (although we had one female as well), they usually show up on the weekends or Monday mornings, and they all have swelling to the hand just below the fourth and fifth fingers. I already know how they hurt themselves, but I ask anyway.
“So how did you hurt your hand?”
[Looking off into space] “I fell.”
[Hobgoblin begins dancing around in WhiteCoat's mind and screaming "Sure you did. Suuuuure you did! Bwaaaaaahahahahahahaha!"]
“Gee, that’s too bad.”
In order to cause a break of the hand at this spot, there has to be a direct force to the end of a closed fist. So by telling me that they “fell,” the patients are trying to convince me that they lost their balance and, in the split second before they hit the ground, their brain sent the response to their hand to make a fist instead of extending their hand.
Riiiiight.
The reflex when one falls is to extend the arm and hand to break the fall, not to make a fist. Falls onto outstretched hands tends to cause another type of fracture - a Colles’ fracture of the wrist. Call me cynical, but I have never seen someone fall onto a closed fist.
Why does this hand fracture occur? First, if you look a the lateral (sideways) xray above, you can see that the bones in the hands aren’t straight, they are bowed a little bit toward the palm.
Now imagine a bow and arrow. If you put one end of the bow on the floor and press down on the other end, the bow will continue to “bow” even more. Keep pressing and eventually the bow will snap - most of the time at the most “bowed” part.
When someone uses the fourth and fifth knuckles (instead of the second and third knuckles) to punch an immovable object such as a wall (or the cranium of another individual), the sudden force focuses on the end of the fifth metacarpal (hand bone), accentuates the pre-existing curvature of the bone, and tends to cause a fracture.
I may not be that smart, but you’re not fooling me on this one.
They’re called Boxer’s Fractures for a reason.
December 12, 2007 at 7:21 pm
Beautiful explanation! I’ve never seen a “fall” cause a boxers fx either. Just some young kid with a temper issue
December 12, 2007 at 9:13 pm
I call them Dumbass Fractures rather than Boxer’s Fractures. Well-trained boxers don’t punch people like that. Drunk dumbasses do.
December 12, 2007 at 9:21 pm
The natural instinct may be to catch yourself with your hands, but not everybody does that. I have an aunt that when she was little ws afrais of hurting her hands when she fell, so she’d put them behind her back. To this day her face takes the brunt of her falls.
(However, I agree that it seems extremely unlikely that a person would make a fist to catch themself as they fall.)
December 12, 2007 at 9:33 pm
I fell…straight into the other guy’s jawbone.
December 12, 2007 at 10:21 pm
My reflex when I fall is to scream like a little girl, but that’s just me…
December 12, 2007 at 10:48 pm
Interesting post Whitecoat and funny. Really if you’re getting a run on these then what IS going on?
Dumbass fractures Nurse K-very funny! LOL!!
I have had 5 HARD falls (yes-I am coordinated-honest)-2 in my twenties on ice, 1 in my 30s on a throw rug on a freshly waxed floor (WHAT was I thinking to wax like that or not use grippers under the rug but went running around the corner after son because he forgot his lunch)and 2 in my 40s tripping on TOYS, going down a step landing on all fours, sliding across the tile on my stomach and stopping when my head hit the closet door. That is when I first injured my meniscus. The 5th on was on some rocks on the jetty and I re-injured the meniscus.
You’re so right about extending arms and hands Whitecoat…I did it every time and as I said landed on all fours.
This is giving me an idea for a post.
Oh and then once on my back…nothing hurt but my pride then.
December 13, 2007 at 12:29 am
My favorites are the guys who punch the wall and find the stud! I also had a 10 yo kid once who punched a metal pole. When I asked him why he did that, he said it was so he wouldn’t hit his little brother.
December 13, 2007 at 12:49 am
You should become involved in forensics
December 13, 2007 at 2:10 pm
First thing we learned in karate school was how to fall. Not until we had that down perfectly did we proceed to the rest of the stuff.
December 14, 2007 at 12:54 am
We’re alot alike except I actually am as dumb as I look.
December 14, 2007 at 10:11 am
I did that once in college. I was playing pick up basketball with some friends, and one of my best friends (he was the best man in my wedding) and I got into a bit of a scrum during the game. I was so pissed at him because of a hard foul that I contemplated hitting him, but punched a wall rather than decking my best friend.
Needless to say, boxer’s fractures suck.
March 11, 2008 at 7:27 am
My first thought is that these kids are probably participating in some type of illegal ‘Fight Club’. Hence, “I fell”. I would think if it was just hitting a wall, the boys would be too macho and would rather be known for ‘hitting a wall’ as opposed to ‘I fell’.
April 12, 2008 at 9:18 am
I did that… laid into a wall three good times, forgot there was CINDERBLOCK behind the wood paneling… absolutely destroyed the poor fifth metacarpal… (Yup, I’m 20, by the way, with some anger issues. ^_^; )
May 22, 2008 at 10:52 pm
My son hit a kid’s head last night. I am pretty sure he has a dumbass fracture. But we haven’t got it xrayed yet. The dumbass told me he wouldn’t wear a splint or cast.
If his hand is fractured and doesn’t heal properly, he could have permanent disability from it - both in terms of shortening/malposition of the bone and in terms of abnormal finger rotation (where the fingers overlap when he makes a fist). I would suggest he get it evaluated.
May 25, 2008 at 11:00 pm
I have a dumbass fracture myself… thats what happens when you down too many shots at once and start punching concrete walls…
June 7, 2008 at 4:03 pm
I really did fall down some steps and into the front of my truck, my right hand must have hit the bumper just right because i have a boxers fracture, looks broke to me in the x-ray. How long before the pain subsides some what. and how long before i can use my hand to wipe my own a? never had this happen to me before. Hurts like help. I dont drink so i was not drunk and i dont take painkillers, so ouch.
June 10, 2008 at 5:33 pm
Im lucky mine wasn’t a knuckle break… mine was broken clean in the middle of the fifth metacarpal which is the bone connected to the pinky in the palm. So far its been 4 weeks now and i use coban wrap at school and a hand brace/splint at home. The swellings gone down but the bump where its broken remains and I cannot flex or move pinky without pain or clench fist. I heard the bone heals around week 6 but the pain and stiffness can last much longer. The doc said to go another 6 weeks after it heals before contact sports or heavy lifting. I’d say after a good two weeks since the break, most pain will be done so that you can do menial tasks such as wiping your butt or opening a door etc…
July 17, 2008 at 11:08 am
I actually did just get this kind of fracture from falling while playing football on the beach.
And the skeptical Dr. did ask me if I hit something.
Luckily I came down on my left hand and I’m right handed, otherwise I’d be completely useless.
July 17, 2008 at 11:10 am
Ah yes, and at first thinking I had dislocated my pinky, had my brother try to relocate by pulling. That hurt.. just a little.
July 18, 2008 at 8:37 pm
I went over the handlebars mountain biking a week a go. All my friends said that my hand was just fine so I put off going to the doctor until today. Well, It seems I have this same break but on my ring finger instead. The doctor says it is very displaced and I see the orthopedic Monday. What kind of treatment can I expect? It is in the exact spot as that picture, just on the ring finger.
July 25, 2008 at 11:06 am
I stumbled at work and my hand hit the metal door frame. I thought I had just slammed the space between my fourth and fifth knuckles; then I looked at my hand. My little finger was at about a seventy degree angle from the rest of my hand. I fractured my fifth metacarpal from mid to distal shaft with dislocation medially of the distal section. Still waiting to see the surgeon. There is a bruise on the tip of my pinkie.
July 28, 2008 at 4:06 am
I’m typing this with one hand thanks to my brawlers fracture. Got angry at a friend of mine and took it out on the side of his head. I told the truth in the ER though and the nurses and doctor I told all seemed suprised by that. Haha.
The pain the first night sucked I couldn’t even sleep. Now 1000 MGs of Hydrocodone every 7 hours is taking care of that!
August 2, 2008 at 11:07 pm
I’m also typing with one hand, my good left, and using my index finger on my right rage-fractured hand. I fractured the pinky bone above the top knuckle. I’m on my four day of being a gimp.
48hrs of quitting smoking, overnight vandalism of my car, and a general collapse of civil living conditions in my condo complex, sent me over the edge. To save a wall at home, I ended up on my knees and left hand while projecting the open cocked shoulder of a right fist of fury into the carpet. For shame the floor boards nor underlay could absorb the rage induced punch as chalkboard, providing I didn’t hit the framing. I pulled up my fist to see the grotesquely submerged pinky knuckle and a big ball of swelling. I knew I had just made a big mistake and had to get to the hospital ASAP. Six hours later, the hand was put in a mid-forearm to finger half-brace. The brace is straight asides from a minor flex at the top knuckle.
I opted for no medication even though I wasn’t offered that luxury. I figured to take the pain like a man and not wear a dress, seeing how I did it by testosterone overload and added to the burden on medical staff. I also didn’t bother anyone to drive me to the hospital and drove myself, thank goodness my car was an auto though or I would have simply took a taxi. Of course my tank was almost empty and I had to stop in and fill up the car. I almost blacked out at the gas station, but a few cups of cold water got the static out of my eyes.
The hand doctor set my appointment for two weeks and this disturbs me. This is two weeks wasted if the bone fracture is poorly aligned in a mere guess calculation from the ground zero break. If the hand specialist needs to re-break the bones, this will be indeed two weeks well wasted. Or if the doctor figures on surgery with pins or wires, I’ll be gimped for many extra weeks.
I’ve read medical reports that a small percentile, if any, of patients claim perfect recovery. Almost every report tells of a likely submerged pinky knuckle and a bump over the break. Aesthetics is one matter, but furthermore, it’s likely that the pinky arc is gimped due to misalignment/bad rotation. I don’t know if this falls under malpractice, but the overall scenarios of the infamous ‘Boxer’s Fractures’ are widespread in certain demographics areas (large urban settings) and should be a mere text book repair. Granted, I type ignorantly as I’ve never taken Med studies and I know nothing about the field. It’s my hand though and I’m scared of it being permanently deficient from a lack of proper care.
I’ve already lost my job to the outcome of my stupid rage outburst and I doubt that I can find another job to pay my mortgage that requires only one hand seeing how most of the job seeking population have two hands. I’m more depressed than usual due to living in fear about my hand and regret/loathing about the initial incident. I am fully aware that the outcome is entirely my fault, but I seek compassion from a doctor along with the money paid for a repair job. I don’t want a gimped hand to regret for the rest of my life along with sequential pain from malpractice. I don’t think my fellow gimps above can disagree. I’m going to prod around and see if I can visit another bone doc before the two weeks. I need my hand, I’m right handed. Thankfully, I had always used my left to wipe my butt. I can’t even fill out a job application form, never mind signing my name. I’m an newly unemployed web designer that can’t even sweep someone’s warehouse floor. Ah well, maybe I’ll be forced into a cretinous telemarketer job to make ends meet. Needless to say, I’m smoking like a factory from stress while friggen cigarettes are eating into my near maxed credit.
I’m atheist, but I actually prayed that my hand will fully recover. The old foxhole story. Alas, luck will rightfully take it’s course one way or the other and hoping for a pleasant end is futile at best.