eMedicine Specialties > Plastic Surgery > Hand

Hand, Thumb Fracture and Dislocations: Workup

Author: Donald R Laub Jr, MS, MD, FACS, Associate Professor, Departments of Surgery and Pediatrics, University of Vermont College of Medicine; Interim Chief of Plastic and Reconstructive Surgery, Fletcher-Allen Health Care
Coauthor(s): Steven V Priano, MD, Assistant Professor of Orthopedic Surgery, Department of Orthopedics and Sports Medicine, Ohio State University College of Medicine and Public Health
Contributor Information and Disclosures

Updated: Oct 8, 2008

Workup

Imaging Studies

  • Radiographs: Obtain standard posteroanterior, lateral, and oblique radiographs in patients with suspected fractures and/or dislocations of the thumb. Traction radiographs may be used to assess the degree of comminution in appropriate fractures (eg, Rolando, comminuted metacarpal base fractures).
    • MCP joint: Evidence of an irreducible thumb MCP dislocation may be indicated radiographically. The presence of a widened MCP joint suggests soft tissue interposition within the joint, indicating a possible irreducible dislocation. The presence of sesamoids within this joint indicates probable volar plate rupture with interposition of this structure within the joint.
    • Skier's and/or gamekeeper's thumb: Occasionally a bony avulsion fracture from the base of the proximal phalanx is observed. Palmar or radial subluxation of the proximal phalanx also may be present.
    • CMC joint: Place the hand's palmar surface flat on the imaging plate for a true lateral view, allowing accurate assessment of the CMC joint. Pronate the hand and wrist approximately 20-30° and direct the imaging beam obliquely at 15° in a distal to proximal direction, centered over the trapeziometacarpal joint. A broken "V" sign may be present on the lateral radiograph, indicating disruption of the normal "V" that is formed by the radial aspect of the trapeziometacarpal articulation. This may indicate undetected CMC joint subluxation.
  • CT and/or tomograms: These studies help define the degree of comminution within a fracture as well as suspected impaction of the articular surface.
  • MRI is the preferred imaging modality to evaluate soft tissues around the thumb. MRI has shown sensitivity and specificity approaching 100% in distinguishing Stener from non-Stener lesions in skier's thumb.12

More on Hand, Thumb Fracture and Dislocations

Overview: Hand, Thumb Fracture and Dislocations
Workup: Hand, Thumb Fracture and Dislocations
Treatment: Hand, Thumb Fracture and Dislocations
Follow-up: Hand, Thumb Fracture and Dislocations
Multimedia: Hand, Thumb Fracture and Dislocations
References
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References

  1. Meals RA, Meuli HC. Carpenter's nails, phonograph needles, piano wires, and safety pins: the history of operative fixation of metacarpal and phalangeal fractures. J Hand Surg [Am]. Jan 1985;10(1):144-50. [Medline].

  2. American Medical Association. The Upper Extremities. In: Concchiarella L, Andersson GBJ. Guides to the Evaluation of Permanent Impairment. 5th ed. AMA Press; 2001:442/chap 16.

  3. de Jonge JJ, Kingma J, van der Lei B, et al. Fractures of the metacarpals. A retrospective analysis of incidence and aetiology and a review of the English-language literature. Injury. Aug 1994;25(6):365-9. [Medline].

  4. Packer GJ, Shaheen MA. Patterns of hand fractures and dislocations in a district general hospital. J Hand Surg [Br]. Aug 1993;18(4):511-4. [Medline].

  5. Stern PJ. Fractures of the metacarpals and phalanges: Fractures of the thumb. In: Green D, Hotchkiss R, Pederson WC. Green's Operative Hand Surgery. 5th ed. Churchill Livingstone; 2005:330-42/chap 8. [Full Text].

  6. Culp R, Ratner J. Acute Thumb injuries. In: Trumble TE, Budoff JE. Hand Surgery Update IV. Chicago, Ill: American Society for Surgery of the Hand; 2007:51-61/chap 4.

  7. Glickel SZ, Barron OA, Catalano LW. Dislocations and ligament injuries in the digits: The thumb carpometacarpal joint. In: Green D, Hotchkiss R, Pedersen WC. Green's Operative Hand Surgery. 5th ed. Churchill Livingstone; 2005:382-88. [Full Text].

  8. Glickel SZ, Barron OA, Catalano LW. Dislocations and ligament injuries in the digits: The thumb metacarpophalangeal joint. In: Green D, Hotchkiss R, Pedersen WC. Green's Operative Hand Surgery. 5th ed. Churchill Livingstone; 2005:366-82/chap 9. [Full Text].

  9. Melone CP Jr, Beldner S, Basuk RS. Thumb collateral ligament injuries. An anatomic basis for treatment. Hand Clin. Aug 2000;16(3):345-57. [Medline].

  10. 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].

  11. Sarris I, Goitz RJ, Sotereanos DG. Dynamic traction and minimal internal fixation for thumb and digital pilon fractures. J Hand Surg [Am]. Jan 2004;29(1):39-43. [Medline].

  12. Connell DA, Pike J, Koulouris G, et al. MR imaging of thumb carpometacarpal joint ligament injuries. J Hand Surg [Br]. Feb 2004;29(1):46-54. [Medline].

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

  14. Berger RA. A technique for arthroscopic evaluation of the first carpometacarpal joint. J Hand Surg [Am]. Nov 1997;22(6):1077-80. [Medline].

  15. Weiland AJ, Berner SH, Hotchkiss RN, et al. Repair of acute ulnar collateral ligament injuries of the thumb metacarpophalangeal joint with an intraosseous suture anchor. J Hand Surg [Am]. Jul 1997;22(4):585-91. [Medline].

  16. Dinowitz M, Trumble T, Hanel D, et al. Failure of cast immobilization for thumb ulnar collateral ligament avulsion fractures. J Hand Surg [Am]. Nov 1997;22(6):1057-63. [Medline].

  17. Drosos GI, Kayias EH, Tsioros K. "Floating thumb metacarpal" or complete dislocation of the thumb metacarpal: a case report and review of the literature. Injury. May 2004;35(5):545-8. [Medline].

  18. Garneti N, Tuson CE. Sagittally split fracture of trapezium associated with subluxated carpo-metacarpal joint of thumb. Injury. Nov 2004;35(11):1172-5. [Medline].

  19. Heyman P. Injuries to the Ulnar Collateral Ligament of the Thumb Metacarpophalangeal Joint. J Am Acad Orthop Surg. Jul 1997;5(4):224-229. [Medline].

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Further Reading

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Keywords

thumb CMC dislocations, thumb CMC fractures, Bennett fractures, Bennett's fractures, Rolando fractures, Rolando's fractures, skier's thumb, gamekeeper's thumb

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Contributor Information and Disclosures

Author

Donald R Laub Jr, MS, MD, FACS, Associate Professor, Departments of Surgery and Pediatrics, University of Vermont College of Medicine; Interim Chief of Plastic and Reconstructive Surgery, Fletcher-Allen Health Care
Donald R Laub Jr, MS, MD, FACS is a member of the following medical societies: American Association for Hand Surgery, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Society for Surgery of the Hand, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, AO Foundation, Association for Academic Surgery, International College of Surgeons, Northeastern Society of Plastic Surgeons, and Vermont State Medical Society
Disclosure: Nothing to disclose.

Coauthor(s)

Steven V Priano, MD, Assistant Professor of Orthopedic Surgery, Department of Orthopedics and Sports Medicine, Ohio State University College of Medicine and Public Health
Steven V Priano, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons
Disclosure: Nothing to disclose.

Medical Editor

Milton B Armstrong, MD, FACS, Associate Professor of Clinical Surgery, Associate Professor of Clinical Orthopedics, Department of Surgery, University of Miami Miller School of Medicine
Milton B Armstrong, MD, FACS is a member of the following medical societies: American Association for Hand Surgery, American Association of Plastic Surgeons, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Medical Association, American Society for Reconstructive Microsurgery, American Society for Surgery of the Hand, and National Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Garry S Brody, MD, MSc, FACS, Professor Emeritus, Department of Surgery, Division of Plastic Surgery, Keck School of Medicine, University of Southern California
Garry S Brody, MD, MSc, FACS is a member of the following medical societies: American Association for Hand Surgery, American Association of Plastic Surgeons, American College of Surgeons, American Society for Head and Neck Surgery, American Society of Plastic Surgeons, California Medical Association, Medical Society of Virginia, and Pan-Pacific Surgical Association
Disclosure: Nothing to disclose.

CME Editor

Nicolas (Nick) G Slenkovich, MD, Director, Colorado Plastic Surgery Center
Nicolas (Nick) G Slenkovich, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society of Aesthetic Plastic Surgery, American Society of Plastic Surgeons, and Colorado Medical Society
Disclosure: Nothing to disclose.

Chief Editor

Subhas Gupta, MD, PhD, CM, FRCS(C), FACS, Professor of Surgery, Chair, Department of Plastic Surgery, Director of Plastic Surgery Residency, Director of Comprehensive Wound Service, Department of Plastic Surgery, Loma Linda University School of Medicine
Subhas Gupta, MD, PhD, CM, FRCS(C), FACS is a member of the following medical societies: American Association of Plastic Surgeons, American Burn Association, American College of Phlebology, American College of Surgeons, American Medical Association, American Medical Informatics Association, American Society of Plastic Surgeons, California Society of Plastic Surgeons, Canadian Medical Association, Canadian Society of Plastic Surgeons, Canadian Society of Plastic Surgeons, College of Physicians and Surgeons of Ontario, Plastic Surgery Research Council, Quebec Medical Association, Royal College of Physicians and Surgeons of Canada, and Wound Healing Society
Disclosure: Nothing to disclose.

 
 
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