Rolando Fracture
Other Names
- 1st metacarpal fracture
- Comminuted intra-articular fracture-dislocation of the base of the proximal first metacarpal
- Rolando fracture
- Comminuted intra-articular fracture of the base of the first metacarpal
- Y-shaped fracture of the first metacarpal base
- T-shaped fracture of the first metacarpal base
- Complex Bennett fracture
- Rolando-type thumb fracture
- Intra-articular thumb metacarpal base fracture
Background
- This pager refers to comminuted intra-articular fracture-dislocation of the base of the proximal first metacarpal
History
- Eponymously named 'Rolando' fracture
- Named after Silvio Rolando, an Italian surgeon who first described the injury in 1910 (need citation)
Epidemiology
- More common in young, adult males[1]
- Rare disease with limited epidemiological characteristics described in published studies
Pathophysiology
General
- Rare, complex, Y- or T- shaped intra-articular fractures at the base of the first metacarpal
- Typically seen in young adult males resulting from high energy trauma
- Requires surgical fixation for anatomic reduction
- Outcomes are mixed with a high risk of post traumatic arthritis
Pathophysiology
- 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
Differential Diagnosis Finger And Hand Pain
- Fractures
- Dislocations
- Tendinopathies
- Extensor Tendon Injuries of the Hand
- Central Slip Extensor Tendon Injury
- Flexor Tendon Injuries of the Hand
- Boutonniere Deformity
- Swan Neck Deformity
- Jersey Finger
- Mallet Finger
- Trigger Finger
- De Quervains Tenosynovitis
- Volar Plate Avulsion Injury
- Sagittal Band Injury
- Mannerfelt Lesion (FPL Rupture)
- Ligament Injuries
- Neuropathies
- Arthropathies
- Nail Bed Injuries
- Pediatric Considerations
- Other
Clinical Features
History
- Patient should be able to describe an acute thumb injury
- E.g. all onto an outstretched hand, direct blow, or sports-related trauma
- Patients report pain, swelling at the base of the thumb
- Lose of function, trouble gripping or pinching objects[6]
- Worse with use of thumb or hand
Physical: Physical Examination Hand
- Inspection: Swelling, bruising
- Palpation: Tenderness at base of thumb, often a visible deformity
- Passive and active range of motion of the thumb elicits significant pain
- Especially with axial loading or opposition
- Range of motion is limited
- Instability or creptius at the carpometacarpal joint
- Generally neurovascularly intact
Evaluation
Radiographs
- Standard Radiographs Hand
- Sufficient to make diagnosis
- Y sign: splitting of the 1st metacarpal base into volar, dorsal fragments
- Robert's View: True AP of thumb
Ultrasound
- Role in Rolando fracture is unclear
- 5% sensitivity and 98.3% specificity for hand fractures[8]
- Water bath technique can help
CT
- Useful to clarify complex fracture patterns
Classification
- N/A
Management
Nonoperative
- Indications
- Generally considered a surgical injury
- Place in Thumb Spica Brace acutely
Operative
- Indications
- All
- Technique
- ORIF
Rehab and Return to Play
Rehabilitation
- After removal of fixation, emphasis on[10]
- Gradual restoration of thumb and hand range of motion
- Tendon-gliding exercises
- Soft tissue mobilization to prevent adhesions and manage scar tissue
- As symptoms improve, functional training and sports specific conditioning
Return to Play/ Work
- There are no evidenced based guideliness for return to play[11]
- Protocols must be individualized based on healing, function, and sport demands
- Early RTP may involve:[12]
- Protective orthoses, gloves, or taping
- Especially in contact sports, to reduce reinjury risk
Prognosis and Complications
Prognosis
- General
- Favorable with appropriate management
- However, carry a high risk of complications due to comminuted, intra-articular nature
- Most patients can expect good functional outcomes and return to previous activity level[1]
- If joint congruity is restored, rehabilitation is adequate
Complications
- Tendon lacerations and neurovascular injuries are uncommon
- Acute Compartment Syndrome
- Post traumatic arthritis
- Malunion
- Joint incongruity
- Long term functional impairment
- Chronic pain and weakness
- Reduced thumb mobility
See Also
Internal
External
- Sports Med Review Hand Pain: https://www.sportsmedreview.com/by-joint/hand/
References
- ↑ 1.0 1.1 Marsland, D., A. P. Sanghrajka, and B. Goldie. "Static monolateral external fixation for the Rolando fracture: a simple solution for a complex fracture." The Annals of The Royal College of Surgeons of England 94.2 (2012): 112-115.
- ↑ Florek, Jakub, et al. "Non-traditional surgical treatment of a Rolando fracture." Cureus 16.9 (2024).
- ↑ Image courtesy of https://surgeryreference.aofoundation.org/, "Metacarpal, Rolando fracture"
- ↑ Case courtesy of Assoc Prof Frank Gaillard, Radiopaedia.org, rID: 35855
- ↑ Image courtesy of journal.aspetar.com
- ↑ Carlsen, Brian T., and Steven L. Moran. "Thumb trauma: Bennett fractures, Rolando fractures, and ulnar collateral ligament injuries." The Journal of hand surgery 34.5 (2009): 945-952.
- ↑ 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.
- ↑ 9.0 9.1 Wang, Wu, et al. "Clinical efficacy of closed reduction and percutaneous parallel K-wire interlocking fixation of first metacarpal base fracture." Journal of orthopaedic surgery and research 16.1 (2021): 454.
- ↑ Hardy, Maureen A. "Principles of metacarpal and phalangeal fracture management: a review of rehabilitation concepts." Journal of Orthopaedic & Sports Physical Therapy 34.12 (2004): 781-799.
- ↑ Geldenhuys, A. Grethe, et al. "Return to play protocols for musculoskeletal upper and lower limb injuries in tackle-collision team sports: A systematic review." European journal of sport science 22.11 (2022): 1743-1756.
- ↑ Singletary, Shannon, Alan E. Freeland, and Christopher A. Jarrett. "Metacarpal fractures in athletes: treatment, rehabilitation, and safe early return to play." Journal of Hand Therapy 16.2 (2003): 171-179.