One Ray, Four Breaks: Isolated Closed Second Ray Fractures in the Dominant Hand,  A Rare and Unusual Pattern of Injury.

Background: Fractures involving multiple phalanges and metacarpal of a single ray are extremely rare, especially in the absence of more widespread hand trauma. We report a unique case of isolated single ray digit fractures involving the metacarpal, proximal, middle, and distal phalanges simultaneously in the dominant hand following a workplace crush injury. Case Presentation: A 34-year-old right-handed male presented to the emergency department with pain and limited mobility in his right dominant hand's index finger after sustaining workplace crush injury. Physical examination revealed tenderness, pain induced reduced ROM and swelling in the affected finger. Radiographs revealed fractures of the metacarpal, proximal phalanx, middle phalanx, and distal phalanx of the same digit. There were no other associated injuries. Surgical fixation by K-wire of the distal and middle phalanyx with close reduction and external slab fixation for proximal and metacarapal bone fractures. 6 weeks after the operation K-wires were removed, the involved joints demonstrated an excellent outcome based on Crawford’s criteria for outcome assessment of mallet finger injury after management. Conclusion: This rare presentation highlights the importance of careful and meticulous evaluation of all phalanges, metacarpals and carpal bones of a single digit in case of crush injuries, as isolated ray involvement can be easily overlooked. Prompt diagnosis and appropriate surgical management can preserve function in such complex injuries.