eMedicine Specialties > Orthopedic Surgery > Hand & Upper Extremity
Rolando Fracture: Workup
Updated: Feb 17, 2009
Workup
Imaging Studies
Anteroposterior (AP) and lateral radiographs of the thumb often do not reveal the full extent of articular comminution (see Image 1).
Lateral radiograph of a Rolando fracture. Note how the comminution is not easily viewed on this film.
Additional radiographic views include a Robert radiograph (a hyperpronated view of the thumb base), tomography (see Images 2-3), and computed tomography (CT) scanning.
Lateral tomograph of a Rolando fracture clearly shows the varus angulation at the fracture, as well as the multiple fragments of the articular surface.
Anteroposterior tomograph of a Rolando fracture further emphasizes the extent of comminution of the articular surface (same patient as in Image above).
Improved assessment of the number of fragments and metaphyseal impaction can aid in decision making for open reduction versus external fixation.
More on Rolando Fracture |
| Overview: Rolando Fracture |
Workup: Rolando Fracture |
| Treatment: Rolando Fracture |
| Follow-up: Rolando Fracture |
| Multimedia: Rolando Fracture |
| References |
| Further Reading |
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References
Breen TF, Gelberman RH, Jupiter JB. Intra-articular fractures of the basilar joint of the thumb. Hand Clin. Aug 1988;4(3):491-501. [Medline].
Foster RJ, Hastings H 2nd. Treatment of Bennett, Rolando, and vertical intraarticular trapezial fractures. Clin Orthop Relat Res. Jan 1987;(214):121-9. [Medline].
Howard FM. Fractures of the basal joint of the thumb. Clin Orthop Relat Res. Jul 1987;(220):46-51. [Medline].
Peterson JJ, Bancroft LW. Injuries of the fingers and thumb in the athlete. Clin Sports Med. Jul 2006;25(3):527-42, vii-viii. [Medline].
Stern P. Fractures of the metacarpals and phalanges. In: Green D, Hotchkiss R, Pederson WC, eds. Green's Operative Hand Surgery. Vol 2. 4th ed. New York, NY: Churchill Livingstone; 1999:763-4.
Rolando S. Fracture of the base of the first metacarpal and a variation that has not yet been described. 1910. Clin Orthop Relat Res. Jun 1996;(327):4-8. [Medline].
Rolando S. Fracture of the base of the first metacarpal and a variation that has not yet been described: 1910. (Translated by Roy A. Meals). Clin Orthop Relat Res. Apr 2006;445:15-8. [Medline].
De Kesel R, Burny F, Schuind F. Mini external fixation for hand fractures and dislocations: The current state of the art. Hand Clin. Aug 2006;22(3):307-15. [Medline].
Kent R, Stacey S, Parenteau C. Dynamic pinch tolerance of the phalanges and interphalangeal joints. Traffic Inj Prev. Mar 2008;9(1):83-8. [Medline].
Byrne AM, Kearns SR, Morris S, Kelly EP. "S" Quattro external fixation for complex intra-articular thumb fractures. J Orthop Surg (Hong Kong). Aug 2008;16(2):170-4. [Medline].
Edmunds JO. Traumatic dislocations and instability of the trapeziometacarpal joint of the thumb. Hand Clin. Aug 2006;22(3):365-92. [Medline].
Geissler WB. Cannulated percutaneous fixation of intra-articular hand fractures. Hand Clin. Aug 2006;22(3):297-305, vi. [Medline].
Spangberg O, Thoren L. Bennett's fracture. A method of treatment with oblique traction. J Bone Joint Surg Br. Nov 1963;45:732-6. [Medline]. [Full Text].
Gelberman RH, Vance RM, Zakaib GS. Fractures at the base of the thumb: treatment with oblique traction. J Bone Joint Surg Am. Mar 1979;61(2):260-2. [Medline]. [Full Text].
Langhoff O, Andersen K, Kjaer-Petersen K. Rolando's fracture. J Hand Surg [Br]. Nov 1991;16(4):454-9. [Medline].
Proubasta IR. Rolando's fracture of the first metacarpal. Treatment by external fixation. J Bone Joint Surg Br. May 1992;74(3):416-7. [Medline]. [Full Text].
Buchler U, McCollam SM, Oppikofer C. Comminuted fractures of the basilar joint of the thumb: combined treatment by external fixation, limited internal fixation, and bone grafting. J Hand Surg [Am]. May 1991;16(3):556-60. [Medline].
Brüske J, Bednarski M, Niedzwiedz Z, Zyluk A, Grzeszewski S. The results of operative treatment of fractures of the thumb metacarpal base. Acta Orthop Belg. Oct 2001;67(4):368-73. [Medline].
Kontakis GM, Katonis PG, Steriopoulos KA. Rolando's fracture treated by closed reduction and external fixation. Arch Orthop Trauma Surg. 1998;117(1-2):84-5. [Medline].
Pehlivan O, Cilli F, Mahirogullari M, Ozyurek S. Management of combined open fractures of thumb metacarpal and trapezium (surgical tip). Hand (N Y). Jun 2007;2(2):48-50. [Medline].
Pelissier P, Sawaya E, Sabri E. Re: "inside screw" wire-frame for internal fixation of intraarticular fracture. J Hand Surg Eur Vol. Apr 2008;33(2):223-4. [Medline].
Schramm JM, Nguyen M, Wongworawat MD, Kjellin I. Does thumb immobilization contribute to scaphoid fracture stability?. Hand (N Y). Mar 2008;3(1):41-3. [Medline].
Soyer AD. Fractures of the base of the first metacarpal: current treatment options. J Am Acad Orthop Surg. Nov-Dec 1999;7(6):403-12. [Medline].
Further Reading
Clinical guidelines and trials:
ACR Appropriateness Criteria® acute hand and wrist trauma. American College of Radiology. 1998 (revised 2005). 8 pages. [NGC Update Pending] NGC:004607
CMC (Carpometacarpal) OA (Osteoarthritis) Thumb Splint Study
Prolotherapy Versus Steroids for Thumb Carpo-Metacarpal Joint Arthritis
Keywords
Rolando fracture, Rolando's fracture, comminuted thumb, metacarpal base fractures, fractures of the thumb base, thumb injury, broken thumb, thumb fracture, juxta-articular metaphyseal fracture, Bennett fracture






Workup: Rolando Fracture