Metacarpal, Rolando fracture

Described by Rolando in 1910, this fracture is a 3-part intraarticular fracture of the base of the thumb metacarpal. These T- or Y-shaped fracture patterns can occur either in the frontal or in the sagittal plane. The mechanism is axial overload along the first metacarpal causing compression of the joint surface.
Today the term “Rolando’s fracture” is often misused to describe multifragmentary intraarticular fractures of the thumb metacarpal base.

Metaphyseal and articular comminution are often more marked than apparent on the x-rays. The full extent of the comminution is often seen only after distraction of the fracture. A preoperative CT scan or traction x-rays are advisable.
Open anatomical reduction and internal fixation is the treatment of choice.

For Y- or T-shaped patterns in the frontal plane, a straight dorsal approach is preferred.
For a Y- or T-shaped fracture pattern in the sagittal plane, the radiopalmar approach is preferred.