- Anatomy of CMC joint
- Bennett's Fracture
- Thumb Fractures / Dislocations
- described in 1910 by Dr. Rolando;
- involves 3 part frx at base of metacarpal;
- in addition to volar lip frx (as seen w/ Bennett's frx), there is also large dorsal frag, resulting in Y or T shaped intra-articular frx;
- frx is a comminuted intra-articular frx at base of thumb metacarpal, even if Y or T is not present;
- frx is uncommon but has a worse prognosis than a Bennet's frx;
- non operative treatment:
- may be indicated in highly comminuted frx
- mold in thumb spica for three to four weeks & then begin ROM;
- surgical treatment:
- indicated for presence of large volar and dorsal fragments amenable to fixation;
- 2.5 cm transverse incision made over radial aspect of thumb metacarpal base;
- dorsal sensory branches of radial nerve are identified & protected;
- EPB & APL are identified & retracted;
- radial artery is protected and retracted ulnarly;
- by traction of thumb metacarpal, trapezial frx is visualized & reduced;
- frx reduction is maintained w/ K wire;
- if radial fragment is large consider using 2.0-mm cortical lag screw may be used, similar to fixation for Bennett frx;
- if only 0.028-inch K wires are used to secure trapezial frx, immobilization is required for six weeks
Rolando's fracture of the first metacarpal. Treatment by external fixation.
Treatment of Bennett, Rolando, and vertical intraarticular trapezial fractures.
Functional cast immobilization of thumb metacarpophalangeal joint injuries.
Fractures at the base of the thumb: treatment with oblique traction.
Dynamic traction and minimal internal fixation for thumb and digital pilon fractures.