My son punched on the wall and is complaining of severe pain. Will it be a fracture?

Hi,

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Sorry to hear about your son's injury. The clinical photograph that you provided (attachment removed to protect patient identity) shows some evidence of soft tissue injury and a small hematoma (a small collection of blood beneath the dermis) in the soft tissue overlying and surrounding his knuckle. It is unfortunately as much as one would be able to tell clinically even after a physical examination. Punching hard surfaces with sufficient force often results in small hairline fractures of one of the carpal bones or fractures of the metacarpal bone. Unfortunately, the only reliable way of telling whether a carpal or metacarpal fracture is by having x-rays taken and having them reported by a competent radiologist or orthopedic surgeon. Leaving a possible minor carpal or metacarpal fracture to heal by itself will often result in healing if the fracture is not displaced, but with high risk that chronic pain may develop in the area for many years with decreased hand functionality. It is therefore not advised. My recommendations to summarize are,X-rays are the only reliable way to exclude a fracture and would be strongly advised. Ice pack and elevation can be used to decrease pain and swelling in the meantime.