Base of Thumb Fracture

Base of Thumb Metacarpal

 

Types

A.  Bennett's

B.  Rolando

- Y shaped intra-articular

 

A.  Bennett's Fracture

 

Bennetts Fracture APBennetts Fracture LateralBennetts CT

 

Fracture

- oblique intra-articular fracture

- small volar fragment remains in situ as attached to beak ligament

- metacarpal displaces proximally and dorsally due to APL

- inherently unstable

 

Management

 

Closed reduction

- longitudinal traction on metacarpal

- use thumb to reduce metacarpal shaft

- use 2 x K wires to pin metacarpal to trapezium / trapezoid

- 6 weeks in thumb spica cast

 

Bennetts FractureBennetts K wireBennetts ORIF

 

Bennett K wires

 

B.  Rolando Fracture

 

Fracture

- 2 small intra-articular fragments

- poor prognosis

 

Operative management

 

Indications

 

Displacement

 

Technique

 

Dorsal approach

- protect superficial radial nerves

- between APL / EPB and EPL

- attempt to anatomically reduce and fix with plate