Annual Report

Executive Editor: Chris Colton

Authors: Renato Fricker, Matej Kastelec, Fiesky Nuñez, Terry Axelrod

Thumb - Metacarpal, base

back to Hand overview

Glossary

General considerations

Extraarticular fractures of the base of the thumb metacarpal are often displaced, with a flexion deformity and may show palmar comminution (Winterstein fracture).

The term “Rolando’s fracture” is often used to describe multifragmentary intraarticular fractures of the thumb metacarpal base. If the fragments are numerous and small it is not advisable to attempt internal fixation, because of the risk of fragment devascularization and the technical difficulty of fixing tiny fragments. In such cases, external fixation with gentle distraction across the joint maintains reasonable reduction of the articular surface and preserves the length of the first metacarpal. Bone grafting of any metaphyseal defect is obligatory.

External fixation
Main indication Skill Equipment
Unstable comminuted fracture with deformity Some specialized surgical experience Simple surgical and imaging resources
Locking compression plate (LCP) fixation
Main indication Skill Equipment
Displaced, angulated fracture with large articular segments Some specialized surgical experience Full specialized surgical and imaging resources

Contraindications

  • Extensive soft tissue loss
  • Gross wound contamination
*Skill
Basic surgical experience, no specialized skills Basic surgical experience, no specialized skills
Some specialized surgical experience Some specialized surgical experience
Highly experienced and skilled surgeon Highly experienced and skilled surgeon
*Equipment
Basic equipment only Basic equipment only
Simple surgical and imaging resources Simple surgical and imaging resources
Full specialized surgical and imaging resources Full specialized surgical and imaging resources

v1.0 2008-11-08