It is a cystic structure with a stalik like base that derives from tendon sheaths or joints. People still do not really know why they form. They may spontaneously resolve or require aspiration. Occasionally if they recur after aspiration, surgery may be required. Historically people struck it with a heavy book---and the heaviest around was the Bible. Dont do it---but it does give another meaning to "Bible bashers".

Males are in fact affected more often than females. Avascular necrosis of the proximal part of the bone is a problem with waist fractures (especially if displaced) because the dominant blood supply comes from distally with retrograde flow.

The dislocated moon shaped lunate can be seen tipped forward on the lateral view (the so called spilled cup sign). On the AP view the carpal bones are not well delineated from each other (crowded carpus) and the lunate now looks triangular (piece of pie or pizza sign).

A Bennett's fracture is a simple oblique fracture at the base of the first metacarpal that goes into the joint whilst a Rolando fracture is a comminuted fracture at the base of the first metacarpal that goes into the joint. Treatment of a Bennett fracture may be conservative or surgical depending mainly on the displacement of the fracture. Gamekeepers thumb is an ulnar collateral ligament injury at the metacarpophalangeal joint of the thumb.

The injury was not diagnosed for 24hrs and did not require surgery. For all you fashionistas note the matching glove, plaster, shoes and handbag.

The lunate is in the correct place but the carpus has gone backwards and dropped. On the way through the scaphoid gets fractured. Nasty injury.

Staph aureus is the most common organism. The 4 Kanavel signs are 1/ A sausage digit. 2/ Finger held in passive flexion. 3/ Pain to percussion/palpation of the flexor sheath. 4/ Pain with passive extension.

It is called a mallet finger because it looks a bit like a mallet. Either the extensor tendon is cut or it has come away with a bit of bone. Initial treatment is in a mallet finger splint which is often enough (4-6wks). Referral to a hand surgeon is pudent because occasionally surgery is required. Oh yes--- do an xray to see if a bit of distal phalanx bone has been pulled off.

No rotation is acceptable. Occasionally they are treated conservatively if there is minimal angulation, no rotation, and it is not an open fracture. However generally they go to OT so get an early orthopaedic opinion.

Terry Thomas was a very British, mainly comedy actor. "Those magnificent men in their flying machines" gets 80% on Rotten Tomatoes. Worth a watch with the kids on a rainy day.