Vol. 3, No.6 November, 1978

Letters to the Editor

603

imal interphalangeal joint injuries must have true lateral roentgenograms. Two of the four of the cases reported here were initially misdiagnosed as being only chip fractures because only anteroposterior and oblique roentgenograms of the hand were obtained. Lewis H. Millender, M.D. 209 Harvard St. Brookline, MA 02146

Another use for the Brewerton view To the Editor: Dr. Charles Lane! has reported the value of the Brewerton view 2 in detecting occult fractures of the metacarpal head. We have also discovered that this view may be helpful in diagnosing occult fractures of the metacarpal base, as demonstrated by the following case report: E. McK., a 23-year-old woman, inadvertently struck the dorsum of her right hand against a machine at work. Radiographs taken by the company physician reputedly were normal. Conservative treatment with 2 weeks of light compression bandaging was unsuccessful in alleviating her symptoms. Examination demonstrated marked local tenderness over the fourth metacarpal base, and percussion along the axis of the fourth ray caused a referred pain to this same area. Our repeat routine radiograph again was normal (Fig. I, A); however, an occult fracture of the fourth metacarpal base was visible in the Brewerton view (Fig. I, B).

Small fractures of the metacarpal bases, particularly of the fourth and fifth metacarpals, can be extremely difficult to detect. We report the Brewerton view as a useful adjunct to routine radiographic projections in detecting these fractures. Jefferson J. Kaye, M.D. Graham D. Lister, F.R.C.S. 1001 Doctors' Office Bldg. 250 E. Liberty St. Louisville, KY 40202

REFERENCES I. Lane CS: Detecting occult fractures of the metacarpal head: The Brewerton view. J HAND SURG 2: 131, 1977

Fig. 1, A, Repeat routine radiograph, which was normal. B, The Brewerton view, which demonstrated an occult fracture of the fourth metacarpal base.

2. Brewerton DA: A tangential radiographic projection for demonstrating involvement of the metacarpal head in rheumatoid arthritis. Br J Radiol 40:233, 1967

Another use for the Brewerton view.

Vol. 3, No.6 November, 1978 Letters to the Editor 603 imal interphalangeal joint injuries must have true lateral roentgenograms. Two of the four of...
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