Fractures and dislocation of the base of the thumb metacarpal

Abstract

Acute traumatic lesions of the base of the first metacarpal are frequent and their consequences can affect the opposition of the thumb. They usually occur after trauma in compression along the axis of the thumb in flexion. Restoring the anatomy and biomechanics of the trapeziometacarpal joint is essential when treating these injuries, hence why surgical treatment is usually indicated. We distinguish trapeziometacarpal dislocations, small-fragment and large-fragment Bennett's fractures, articular three-fragment Rolando and comminutive fractures and extra-articular fractures of the base of the first metacarpal. All carry the risk of narrowing of the first web. Recent studies have described poor results with conservative treatment. Surgical techniques are varied: percutaneous surgery, open surgery and arthroscopic surgery. The techniques of osteosynthesis are various: locking plates, and direct or indirect screw fixation or pinning. The prognosis depends on the quality of the restoration of the mobility of the trapeziometacarpal joint.

Casting and Splinting Management for Hand Injuries in the In-Season Contact Sport Athlete

“…The fracture occurs as a result of a force across the long axis of a partially flexed metacarpal (Figure 1). 4,10,19,21 …”

Emergency and Trauma of Hand and Wrist

“…Metacarpal thumbs are a result of axial loading with a flexed metacarpophalangeal (MCP)1 joint. 110 Metacarpal thumb fractures can be divided into extra-articular, comminuted, intra-articular two-part (Bennett's fracture), and intraarticular comminuted (Rolando's fracture) 110 (►Fig. 12).…”

“…9 Bennett's fracture has an oblique or vertical fracture line through the base. 110 A small triangular bone fragment at the ulnar side remains attached to the trapezium because of the volar beak ligament. 27 The metacarpus is dorsally and radially displaced due to the pull of the extensor pollicis longus and brevis and the abductor pollicis longus tendons.…”

Treatment of Rolando Fractures by Open Reduction and Internal Fixation using Mini T-Plate and Screws

“…Intra-articular fractures involving the base of the first metacarpal assume significance because any residual incongruity or subluxation at the carpometacarpal joint can produce loss of motion, especially the opposition, as well as progressive secondary arthritis with serious functional disability. 1,2 Introduction Rolando fractures being intra-articular fractures of the most mobile joint of the thumb, assume significance because any residual incongruity of the articular surface may result in loss of motion as well as secondary osteoarthritis and hence serious disability. This fracture continues to pose difficulties to the treating surgeons and although several treatment options have been described for these fractures, there are no definite guidelines.…”

“…4 The mechanism of injury in these fractures is an axial force directed through the partially flexed metacarpal shaft resulting in a dorsal and a palmar fragment with or without variable communition. 2,4,5 The abductor pollicis tendon pulls the lateral epiphyseal fragment upwards and outwards while as the medial epiphyseal fragment is maintained in position by virtue of its attachment to the trapezium by an oblique posteromedial ligament. 2,4 Rolando stated that the prognosis in these fractures was poor after both cast treatment as well as skin traction.…”