Venous bullet embolism: a case report and review of the literature

Abstract

These two cases present an uncommon mechanism resulting in a spiral fracture of the proximal phalanx of the index finger, which to our knowledge has not been reported previously in the English literature. This fracture is produced by a rotary force during traction. It clearly demonstrates the strength of the ligamentous structures of the metacarpophalangeal and proximal interphalangeal joints, i.e. instead of rupture of these structures, the bone appeared to be weaker leading to a spiral fracture of the proximal phalanx. A spiral fracture of the humerus due to a more or less similar mechanism as a result of violent muscle activity has been reported for throwing sports and arm wrestling (Helm and Stuart, 1986; Marymont et al., 1989; Noack and Rottinger, 19%). Both bony union of such spiral fractures and recovery of function is usually fast because of the indirect nature of the violence and the relatively little soft tissue damage.