Diagnostic Assessment — Right Hand Fifth Metacarpal - Undisplaced Fracture
Example 1 of 1 · fictitious patient (Veteran C)
Diagnostic Assessment
Right Hand Fifth Metacarpal - Undisplaced Fracture
Balance of Probabilities SOP: Fracture No. 63 of 2024 Reasonable Hypothesis SOP: Fracture No. 64 of 2024
ADF History
The veteran, Communications and Information Systems Controller, enlisted 28 July 1986, discharged 22 Mar 2003.
Occupational History
As a Communications and Information Systems Controller (CISCON), the veteran was exposed to physical training demands, equipment handling, and recreational activities that increased the risk of traumatic injuries. Military training involved contact sports, physical exercises, and activities that could result in falls or direct trauma to the hands during training or recreational periods.
History
The veteran the veteran a CISCON in the RAAF, sustained an undisplaced fracture of the neck of the fifth metacarpal in December 1989 after striking a wall during a service-related incident.
Timeline
- 22 November 1986: The veteran presented with right hand pain after striking a wall, causing tenderness over the snuff box, lateral radial area, and metacarpophalangeal region of the little finger. The incident occurred during service, resulting in immediate pain and functional limitation of the right hand, particularly affecting the little finger region.
- 25 November 1986: X-ray examination confirmed an undisplaced fracture of the neck of the fifth metacarpal and a chip fracture of the middle phalanx of the little finger. The radiological findings showed stable fractures with no significant displacement, consistent with the mechanism of injury from striking a hard surface.
- 28 November 1986: Orthopedic review by specialist who noted minimal tenderness and questioned the X-ray findings, describing the injuries as minimal. The orthopedic surgeon recommended encouraging normal hand use and avoiding contact sports for 3 weeks, indicating conservative management was appropriate given the stable nature of the fractures.
Symptoms
At the time of injury, the veteran experienced immediate pain and tenderness over the metacarpophalangeal region of the little finger, with functional limitation of hand use. The symptoms were consistent with acute fracture pain and local inflammation. Following conservative management, symptoms gradually resolved with return to normal function, though the structural changes from the healed fracture remained permanent.
Imaging
- 25 November 1986: X-ray findings showed undisplaced fracture of the neck of the fifth metacarpal
1. What is the formal diagnosis of the condition claimed above?
Right Hand Fifth Metacarpal - Undisplaced Fracture (S62.306) DVA SOP: Fracture No. 63 of 2024 (Balance of Probabilities), Fracture No. 64 of 2024 (Reasonable Hypothesis) ICD-10 Code: S62.306
A fracture is an acquired break of bone as a result of an applied force that ordinarily would cause bone breakage in a healthy bone. An undisplaced fracture of the fifth metacarpal neck, commonly known as a "boxer's fracture," typically occurs from axial loading of a clenched fist against a hard object. The fifth metacarpal neck is the most common site of metacarpal fracture due to its anatomical vulnerability. Undisplaced fractures maintain normal bone alignment and typically heal well with conservative management.
2. For each diagnosis identified, please also provide the following dates:
When did the veteran first experience symptoms attributable to this condition? The veteran first experienced symptoms on 22 November 1986 when he struck a wall, causing immediate pain and tenderness in the right hand. [WAGGA MEDICAL IMAGING, UMR - 200 - 400.pdf, Page 18] [MR. ALAN NICHOLLS FRACS FAORTHA, UMR - 200 - 400.pdf, Page 24]
When did the veteran first present to a health / medical provider for this condition? The veteran first presented for medical assessment on 22 November 1986 following the injury from striking a wall, with clinical evaluation documenting tenderness over the affected area. [MR. ALAN NICHOLLS FRACS FAORTHA, UMR - 200 - 400.pdf, Page 24]
When was the condition confirmed / formally diagnosed? The fracture was formally diagnosed on 25 November 1986 via X-ray examination, which confirmed the undisplaced fracture of the neck of the fifth metacarpal. [WAGGA MEDICAL IMAGING, UMR - 200 - 400.pdf, Page 18]
When did the veteran first present to you (or your practice) for this condition? 31 July 2015.
3. How was this diagnosis confirmed? i.e. what were the key symptoms and signs, investigation results, specialist opinions? Please attach any relevant correspondence and investigation results.
The diagnosis was confirmed through X-ray imaging on 25 November 1986, which demonstrated an undisplaced fracture of the neck of the fifth metacarpal. Key symptoms included immediate pain and tenderness over the metacarpophalangeal region following trauma from striking a wall. Clinical examination revealed tenderness over the snuff box, lateral radial area, and metacarpophalangeal region of the little finger. Specialist orthopedic review on 28 November 1986 confirmed the minimal nature of the fracture and recommended conservative management. [WAGGA MEDICAL IMAGING, UMR - 200 - 400.pdf, Page 18] [MR. ALAN NICHOLLS FRACS FAORTHA, UMR - 200 - 400.pdf, Page 24] [SPECIALIST REFERRAL AND REPORT, UMR - 200 - 400.pdf, Page 25]
4. What do you consider to be the cause(s) of the condition in this veteran? Give consideration to constitutional and common risk factors, pre-existing injuries or diseases, and occupational or lifestyle risks, as well as direct causative mechanisms.
Having significant physical force applied to or through the affected bone at the time of clinical onset - This factor requires significant physical force applied to the bone causing the fracture.
- MET: The veteran struck a wall with his fist on 22 November 1986, applying significant physical force directly to the fifth metacarpal bone. This mechanism is consistent with the typical cause of fifth metacarpal neck fractures and directly resulted in the undisplaced fracture confirmed by X-ray examination.
Inability to obtain appropriate clinical management for fracture before clinical worsening - This factor examines whether appropriate clinical management was available and provided for the fracture.
- NOT MET: The veteran received appropriate and timely clinical management, including prompt X-ray diagnosis within 3 days of injury, orthopedic specialist review, and appropriate conservative management recommendations. There is no evidence of clinical worsening or inadequate management.
Sequelae
This condition is not considered a sequelae of another known condition but rather represents a primary traumatic injury from direct force application.
Unintended Consequence
The condition is not considered an unintended consequence of medical management, as it resulted from a traumatic incident rather than medical intervention.
Inability to Attain Appropriate Medical Management
The veteran received prompt and appropriate medical management for this fracture. He was assessed within days of the injury, received appropriate X-ray imaging, and had specialist orthopedic review with appropriate conservative management recommendations. There is no evidence of inability to obtain appropriate clinical management for this condition. As established in Brew v Repatriation Commission (19 July 1990), the veteran had full access to necessary medical care and received treatment consistent with the standards of the time.
The % contribution of the causes is 100% and significant.
5. Please provide a Health Summary and a medication / prescribing history. -see attached report
