Authors of section

Authors

Renato Fricker, Matej Kastelec, Fiesky Nuñez, Terry Axelrod

Executive Editor

Chris Colton

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Nonoperative treatment

1. Introduction

Rolando’s 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 causative mechanism is axial overload along the first metacarpal causing compression failure of the joint surface.

Today, the term “Rolando’s fracture” is often misused to describe multifragmentary intraarticular fractures of the thumb metacarpal base.

Today the term “Rolando’s fracture” is often misused to describe multifragmentary intraarticular fractures of the thumb ...

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, as demonstrated in the images.
A CT scan, or traction x-rays, are advisable.

If the fracture can not be reduced anatomically, open reduction and internal fixation must be performed.

If the fracture can not be reduced anatomically, open reduction and internal fixation must be performed.

Teaching video

AO teaching video: Application of the thumb spica

2. Reduction

Apply traction

As there is usually a flexion deformity, reduction of the diaphyseal fragment to the articular fragments can be performed with axial traction on the thumb and simultaneous pressure over the dorsal aspect of the basal diaphysis near the fracture.

As there is usually a flexion deformity, reduction of the diaphyseal fragment to the articular fragments can be performed ...

3. Applying cast

Maintaining reduction

During the application of the cast, it is important to exert pressure over the dorsal aspect of the first metacarpal diaphyseal base, and from the palmar aspect over the first metacarpal head.

During the application of the plaster, it is important to exert pressure from the dorsal side onto the first metacarpal ...

Pitfall: palmar pressure

Avoid pressing from the palmar aspect over the base of the proximal phalanx. This results in redisplacement of the fracture and hyperextension of the MCP joint.

During the application of the plaster, it is important to exert pressure from the dorsal side onto the first metacarpal ...

Apply the cast

Immobilize the wrist in a well-padded below-elbow plaster with the wrist slightly extended, and the thumb immobilized in a position of slight abduction.

Immobilize the wrist in a well-padded below-elbow plaster with the wrist slightly extended, and the thumb immobilized in a ...

Make sure that the cast does not extend too far distally, either at the level of the finger metacarpophalangeal joints (MCP), or the interphalangeal joint of the thumb. The cast must not limit complete flexion of these joints.

Make sure that the plaster does not extend too far distally, both at the level of the metacarpophalangeal joints (MCP) II-V ...

4. Aftertreatment

Confirm reduction by radiographs after the plaster has been applied. Repeat radiographs in weekly intervals until healing. Usually, immobilization for a 6 week period is sufficient.

The patient is instructed to regularly exercise the MCP joints and interphalangeal joints of the fingers, and the interphalangeal joint of the thumb.

nonoperative treatment