Because of the mobility of the thumb metacarpal, shaft fractures are uncommon. Fractures usually involve the base.
EXTRAARTICULAR Extraarticular fractures are due to a direct blow or impaction mechanism. The mobility of the CMC joint can allow for 20° angular deformity. Angulation greater than this requires reduction and thumb spica splint for 4 weeks. Spiral fractures often require fixation.
INTRAARTICULAR Intraarticular fractures are due to impaction from striking a fixed object. Two fracture types have been described.
BENNETT FRACTURE A Bennett fracture is an intraarticular fracture with associated subluxation or dislocation at the CMC joint. The ulnar portion of the metacarpal usually remains in place. The distal portion usually subluxes radially and dorsally from the pull of abduction pollicis longus and the adductor pollicis. Treatment includes thumb spica splint and surgical referral.
ROLANDO FRACTURE A Rolando fracture is an intraarticular comminuted fracture at the base of the metacarpal. The mechanism of injury is similar to the Bennett fracture, but less common. Treatment includes thumb spica splint and surgical consultation.
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