eMedicine Specialties > Orthopedic Surgery > Hand & Upper Extremity

Rolando Fracture: Follow-up

Author: John J Walsh IV, MD, Associate Professor, Department of Orthopedic Surgery, University of South Carolina School of Medicine
Contributor Information and Disclosures

Updated: Feb 17, 2009

Outcome and Prognosis

In a study by Langhoff et al, 16 patients had a mean follow-up of 5.8 years following open reduction with fine K-wires.15 Nine had no residual symptoms, 6 had symptoms with moderate activity, and 1 had significant symptoms that required a change in occupation. Reduced range of motion was noted in 8 patients, and 3 had a visible deformity of the thenar base region that was related to large residual angulations of 35-55 degrees. Of the 11 patients with radiographs at follow-up, osteoarthritic changes were present in 6 (55%); this did not appear to correlate with the quality of reduction or with late symptoms.

Proubasta reported the results of 5 patients treated with a mini–external fixator.16 Pins were placed in the trapezium and thumb metacarpal shaft, and the fracture was reduced with distraction. At short-term follow-up at 3 months, no complications were noted, and the patients all were free from pain and had a full range of thumb movements.

Buchler and coauthors reviewed their experience in the management of 13 complex thumb metacarpal base fractures in which multiple fragments were involved.17 The authors treated the fractures with external fixation between the index and thumb metacarpals and limited internal fixation of the joint surface using pins and/or screws. Buchler et al performed bone grafting of the metaphyseal void present after distraction.

The average duration of follow-up was 35 months. No significant complications developed, and no loss of reduction, malalignment, or secondary subluxation developed. Grip and pinch strength were 81% and 88% of the contralateral side, respectively. Rotation of the thumb metacarpal was 79% of the unaffected side. No diffuse degenerative changes developed.

Future and Controversies

Future research will help to identify fractures that safely can be managed with internal fixation alone, as well as help to differentiate these injuries from the more severely comminuted fractures that need external fixation for ligamentotaxis and protection of the fracture.

 


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

  1. 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].

  2. Foster RJ, Hastings H 2nd. Treatment of Bennett, Rolando, and vertical intraarticular trapezial fractures. Clin Orthop Relat Res. Jan 1987;(214):121-9. [Medline].

  3. Howard FM. Fractures of the basal joint of the thumb. Clin Orthop Relat Res. Jul 1987;(220):46-51. [Medline].

  4. 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].

  5. 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.

  6. 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].

  7. 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].

  8. 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].

  9. 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].

  10. 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].

  11. Edmunds JO. Traumatic dislocations and instability of the trapeziometacarpal joint of the thumb. Hand Clin. Aug 2006;22(3):365-92. [Medline].

  12. Geissler WB. Cannulated percutaneous fixation of intra-articular hand fractures. Hand Clin. Aug 2006;22(3):297-305, vi. [Medline].

  13. 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].

  14. 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].

  15. Langhoff O, Andersen K, Kjaer-Petersen K. Rolando's fracture. J Hand Surg [Br]. Nov 1991;16(4):454-9. [Medline].

  16. 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].

  17. 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].

  18. 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].

  19. 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].

  20. 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].

  21. 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].

  22. 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].

  23. 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].

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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

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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

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Contributor Information and Disclosures

Author

John J Walsh IV, MD, Associate Professor, Department of Orthopedic Surgery, University of South Carolina School of Medicine
John J Walsh IV, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Society for Surgery of the Hand, and Christian Medical & Dental Society
Disclosure: Nothing to disclose.

Medical Editor

A Lee Osterman, MD, Director of Hand Surgery Fellowship, Director, Philadelphia Hand Center; Director, Professor, Department of Orthopedic Surgery, Division of Hand Surgery, University Hospital, Thomas Jefferson University
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Michael Yaszemski, MD, PhD, Associate Professor, Departments of Orthopedic Surgery and Bioengineering, Mayo Foundation, Mayo Medical School
Disclosure: Nothing to disclose.

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Harris Gellman, MD, Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami School of Medicine
Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery of the Hand, and Arkansas Medical Society
Disclosure: Nothing to disclose.

 
 
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