Thumb fractures
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Transcript of Thumb fractures
Thumb Metacarpal Fractures
Alan M. Hirahara, M.D.
Fracture Classification
Intra-articular
I - Bennett Fx
II - Rolando Fx
Extra-articular
IIIA - Transverse
IIIB - Oblique
IV - Children’s physeal
Bennett’s Fracture
• Fracture-dislocation
• First described by Bennett in 1882
• Mechanism of injury– Axial blow directed against the partially flexed
metacarpal– Commonly sustained in fistfights
Bennett’s Fracture
• Fracture line separates major part of MC from small volar lip fragment, producing disruption of CMC joint
Bennett’s Fracture
• Avulsion rather than pure dislocation secondary to strength of anterior oblique ligament (AOL), which anchors volar lip of MC to tubercle of trapezium
Bennett’s Fracture
• Primary variables– Size of volar lip
fragment
– Amount of displacement of shaft
• Associated injuries– Trapezium fractures
– Rupture of MP joint collateral ligaments
Deformity
• Primary forces– Base of MC pulled
dorsally & radially by AbdPL
– Distal attachment of adductor levers base further dorsally
Treatment
• Closed Reduction
• Percutaneous Pin Fixation– Trans-meta
– Trapezium-MC
– Intramedullary
• Open Reduction, Internal Fixation– Herbert screw
– AO screw
• External Fixator
Treatment
• Accept 2 mm displacement– Criteria not well established– OKU Hand & Campbell’s - Accepts 1-3 mm
• 4 weeks thumb spica cast
Bennett Fx - Options
Bennett Fx - CRPP 1
Bennett Fx - CRPP 2
Bennett Fx - CRPP 3
Bennett Fx - CRPP 4
Bennett Fx - ORIF
Rolando’s Fracture
• Rolando described fracture in 1910– Volar lip fragment & large dorsal fragment,
resulting in Y- or T-shaped intra-articular fracture
– Commonly severe comminution
• Least common of adult thumb MC fx
• Prognosis - Poor
Rolando Fx - Xray 1
Rolando Fx - Xray 2
Treatment
• ORIF only attempted if volar & dorsal components are single large fragments
• Traction
• External Fixation
• Limited immobilization with early attempt at remolding via mobilization
Rolando Fx - ORExFix 1
Rolando Fx - ORExFix 2
Rolando Fx - Ex Fix
Rolando Fx - ORIF
Extra-articular Fractures
• Most frequent fracture in thumb metacarpal
• Surgery rarely indicated
• Closed manipulation under regional or local anesthesia
• Spica cast x 4 weeks
Extra-articular Fx - Xray
Extra-articular Fractures
• Avoid hyperextension of MP joint
• Failure to achieve exact alignment not an indication for open reduction
• Can accept 20-30° of residual angulation, without detectable limitation of motion
• Oblique type – With marked vertical inclination, percutaneous
pinning may be necessary
Extra-articular Fx - CRPP