Metacarpal, base

 Principles

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.

 Treatment options

  1. Conservative treatment
    Indicated for undisplaced fractures.
  2. Closed reduction and internal fixation
    Indicated for reducible fractures.
  3. Open reduction internal fixation (ORIF)
    Indicated for fractures which are not reducible in a closed manner.
    ORIF is also indicated in high-demand patients and those who need immediate restoration of a full range of motion. However, ORIF is possible only if the anterior marginal fragment is large enough for internal fixation (>20% of the articular surface).

 Extraarticular thumb base fracture

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

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v1.0 2008-11-08