eMedicine Specialties > Orthopedic Surgery > Hand & Upper Extremity

Rolando Fracture: Treatment

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

Treatment

Surgical Therapy

If open reduction is thought to be a reasonable choice for the patient with a Rolando fracture, a curvilinear incision is made at the thumb base. Branches of the superficial radial nerve dorsally and lateral antebrachial cutaneous nerve volarly are identified with loupe magnification, isolated, and protected. The periosteum is split along the first metacarpal shaft, and the joint is entered in the interval between the abductor pollicis longus and extensor pollicis brevis tendons. Large articular fragments are identified. The articular surface is reconstructed in a piecemeal fashion with fine Kirschner wires (K-wires) and then secured to the metacarpal shaft using a small T plate (see Image 4). Obtain intraoperative radiographs to confirm a satisfactory reduction, and place the limb in a thumb spica splint.

Radiograph of a healed Rolando fracture following...

Radiograph of a healed Rolando fracture following fixation of the articular surface and neutralization with a small plate.

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Radiograph of a healed Rolando fracture following...

Radiograph of a healed Rolando fracture following fixation of the articular surface and neutralization with a small plate.


Comminuted metacarpal base fractures that cannot be secured with pins or screws can be treated with external fixation.8,10,11,12 One technique involves a quadrilateral frame with 2 pins each in the thumb and index metacarpal, limited K-wire fixation of the articular surface, and bone grafting of any metaphyseal void that has been created after length restoration. Another technique involves placing fixator pins in the trapezium and metacarpal shaft to maintain distraction.

Byrne et al recommended dynamic "S"-Quattro (Stockport Serpentine Spring System) as a primary and definitive treatment modality for external fixation of complex fractures of the base of the thumb when conservative and other surgical interventions have failed.10

Spangberg and Thoren described the use of oblique K-wire traction in the treatment of Bennett fracture.13 Gelberman expanded this to include comminuted metacarpal base fractures and trapezial fractures.14 The technique involves use of a single K-wire that is passed from the metacarpal base out of the thumb web, with a small hook on the proximal end of the wire. The distal end is then attached to an outrigger through rubber bands. Active motion is started to mold the joint surface. This traction neutralizes displacing muscle forces and maintains reduction through ligamentotaxis.

Follow-up

Secure plate fixation can allow early motion of the joint surface. However, if the comminution requires grafting and stability is a concern, immobilization in a thumb spica cast for 4-6 weeks is the safest course of action. External fixation and/or K-wires can be removed at approximately 6 weeks postoperatively, and active motion can begin.

Complications

Complications are often directly related to the extent of the comminution. Hardware-related issues can develop, such as pin tract infection or screw pullout with resultant loss of fixation. Soft-tissue complications include damage to the nerve branches of the superficial radial or lateral antebrachial cutaneous nerve. Some degree of joint stiffness is inevitable, given the articular nature 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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