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Rolando Fracture
From WikiSM
Contents
Other Names
- 1st metacarpal fracture
- Comminuted intra-articular fracture-dislocation of the base of the proximal first metacarpal
- Rolando fracture
Background
- This pager refers to comminuted intra-articular fracture-dislocation of the base of the proximal first metacarpal
- Eponymously named 'Rolando' fracture
History
- Named after Italian surgeon Sylvio Rolando (need citation)
Epidemiology
Pathophysiology
Illustration of Rolando fracture[1]
Intra-articular fracture/dislocation of the first metacarpal (aka Rolando fracture).[2]
- General
- Definition: comminuted intra-articular fracture-dislocation of the base of the proximal first metacarpal
- Axial load to a partially flexed thumb
- Unopposed muscles contribute to displacement
Risk Factors
- unknown
Differential Diagnosis
- Fractures
- Dislocations
- Tendinopathies
- Ligament Injuries
- Neuropathies
- Arthropathies
- Nail Bed Injuries
- Pediatric Considerations
- Other
Clinical Features
- History
- Patients report pain, swelling at the base of the thumb
- Worse with use of thumb or hand
- Physical: Physical Examination Hand
- Inspection: Swelling, bruising
- Palpation: Tenderness at base of thumb
Evaluation
Comminuted intra-articular fracture-dislocation of the base of the thumb (proximal first metacarpal).[3]
Radiographs
- Standard Radiographs Hand
- Robert's View: True AP of thumb
- Y sign: splitting of the 1st metacarpal base into volar, dorsal fragments
Ultrasound
- Role in Rolando fracture is unclear
- 5% sensitivity and 98.3% specificity for hand fractures[4]
- Water bath technique can help
CT
- Useful to clarify complex fracture patterns
Classification
- N/A
Management
Nonoperative
- Indications
- General considered a surgical injury
- Place in Thumb Spica Brace acutely
Operative
- Indications
- All
- Technique
- ORIF
Rehab and Return to Play
Rehabilitation
- Needs to be updated
Return to Play/ Work
- Needs to be updated
Complications and Prognosis
Prognosis
- Needs to be updated
Complications
- Tendon lacerations and neurovascular injuries are uncommon
- Acute Compartment Syndrome
See Also
External
- Sports Med Review Hand Pain: https://www.sportsmedreview.com/by-joint/hand/
References
- ↑ Image courtesy of https://surgeryreference.aofoundation.org/, "Metacarpal, Rolando fracture"
- ↑ Case courtesy of Assoc Prof Frank Gaillard, Radiopaedia.org, rID: 35855
- ↑ Case courtesy of Dr MT Niknejad, Radiopaedia.org, rID: 61566
- ↑ Blaivas, Michael, et al. “Water bath evaluation technique for emergency ultrasound of painful superficial structures.” The American journal of emergency medicine 22.7 (2004): 589-593.