Management of Rolando Fracture by Modified Dynamic External Fixation

Abstract

Rolando fracture is one of the most difficult fractures facing hand surgeons. It can be described as a Y- or T-shaped fracture line that runs longitudinally through the metaphyseal area, with an intra-articular fracture splitting the metacarpal base fragment into a volar and a dorsal fragment. In this study, we introduce our technique used in the management of 7 cases, which were treated by our dynamic external fixation. The results were found to be promising, with an excellent range of motion and power grip postoperative. The joints spaces were restored. No patients in our series developed arthritic changes. All patients are pain free in 3 months.

Static monolateral external fixation for the Rolando fracture: a simple solution for a complex fracture

“…However, our patient series is relatively small and randomised controlled trials are necessary to determine the optimal pin configuration. Other authors have advocated the use of relatively more complex dynamic constructs; 12,23 the excellent functional results of our series suggest such dynamic constructs have no obvious advantage over this simple, static construct.…”

“…22 Previous studies have shown good outcomes with external fixation but are limited by their size (only one other series is larger than that presented here) and none have used an objective functional score. [12][13][14]21,23 The advantages of the technique described here include the use of only a single pin in the trapezium and first metacarpal respectively, and a simple, single bar, static monolateral construct (Fig 2). Previously described techniques have used two pins in either the first metacarpal, 13 the trapezium or both.…”

“…In only one patient was early removal of the fixator required and this patient reported a worse functional outcome compared to the rest of the group. In other patient series reporting the results of Rolando fractures treated with external fixation, the pin site infection rates range from 20% 13 to 85% 12 and the infection appears to be easily treated with oral antibiotics. We recommend careful dissection when inserting the half pins in order to avoid transfixing soft tissues, which can increase infection rates.…”

“…3,9,10 External fixation is one option in this situation but there are few clinical series published. [11][12][13][14] We describe a simple, new technique for the treatment of the Rolando fracture with a static two-pin external fixator spanning the trapeziometacarpal joint and present the functional outcome in eight cases.…”

An Evidence-Based Approach to Metacarpal Fractures

“…25 Other practitioners have utilized external fixation for Bennett or Rolando fractures: Niempoog and Waitayawinyu reported 100 percent union and good clinical results for Rolando fractures (Level IV Evidence), 26 while El-Sharkawy et al also claims good results with dynamic external fixation for Rolando fractures (Level V Evidence). 27 Like nonthumb metacarpals, no single operative fixation modality has been demonstrated to be superior to others when treating fractures of the thumb metacarpal.…”