Yeah right you fell

A patient walks in holding his hand in pain, saying that his hand has been hurting since this morning. He claims that he just "woke up" with the pain, and on examination there is swelling of his hand along with tenderness around the 4th/5th metacarpal.

It was pretty obvious what had happened, but we asked him again, and still he insisted that he just woke up with this problem.

So we sent him off for an x-ray.

Which, to nobody's surprise but perhaps the patient's own, came back looking something like this:

Pointy arrow says "hello fracture!"

For the uninitiated, this is a distal fracture of the 5th metacarpal, also known as Boxer's fracture, due to the nature of how this injury is commonly sustained.

Despite what patients will have you believe, the only way you can fracture your metacarpal like that is by punching something (or someone, you never know).

In my short A & E stint I've become a bit of an expert at looking at these fractures, thanks to the crazy amount of people who turn up in the department claiming that they fell or don't know where this pain came from it just magically popped out of nowhere or straight out admit they've been punching walls in anger etc etc.

I'd like to see someone try falling onto their closed fist.

You have to give this guy credit for sticking to his guns, even though we told him there was no other plausible way he could've fractured his hand unless he's gone around punching walls, he still insisted he woke up with it.

Perhaps he's been punching things in his sleep? I worry for his wife.