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.
|Unstable comminuted fracture with deformity|
|Locking compression plate (LCP) fixation|
|Displaced, angulated fracture with large articular segments|
- Extensive soft tissue loss
- Gross wound contamination
|Basic surgical experience, no specialized skills|
|Some specialized surgical experience|
|Highly experienced and skilled surgeon|
|Basic equipment only|
|Simple surgical and imaging resources|
|Full specialized surgical and imaging resources|