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Malisorn S. The Current Concept and Evidence-Based Practice in the Base of the First Metacarpal Bone Fracture. Cureus 2024; 16:e51600. [PMID: 38173948 PMCID: PMC10764075 DOI: 10.7759/cureus.51600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2024] [Indexed: 01/05/2024] Open
Abstract
Repetitive instances of sudden injuries to the first metacarpal bone can affect thumb movement. These injuries typically occur after vertical impact to the thumb. The treatment for these injuries should focus on restoring the structure and biomechanics of the trapeziometacarpal joint, with surgery being recommended for optimal results. Bennett's fracture involves the bifurcation of the bone into two distinct fragments, characterized by a smaller fragment and a larger counterpart. Rolando fracture is associated with a fracture of the base of the first metacarpal bone, typically divided into three parts. An extra-articular fracture involves the metacarpal bone of the thumb. Conservative treatment outcomes have been found to be unsatisfactory when the fracture is displaced. Therefore, surgery methods such as minimally invasive surgery, open reduction, and arthroscopic surgery have been proven to be effective. Surgical techniques for bone procedures include pin fixation, direct screw fixation, indirect screw fixation, and mini-plate fixation. Additionally, the prognosis of this condition depends on the ability to restore joint mobility during rehabilitation.
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Chalidis BE, Kitridis D, Gigis I, Givissis PK. Trapeziometacarpal External Fixation under Local Anesthesia for the Treatment of Comminuted Intra-Articular Thumb Metacarpal Fractures: Evaluation of Clinical Results and Long-Term Patient Satisfaction. J Wrist Surg 2023; 12:301-305. [PMID: 37564621 PMCID: PMC10411102 DOI: 10.1055/s-0042-1749146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 03/24/2022] [Indexed: 10/18/2022]
Abstract
Background A variety of internal and external fixation techniques have been described for the treatment of Rolando fractures, but the optimal fixation method has not been clearly defined. Purpose The aim of the study was to describe the results and the long-term functional outcome of the application, under local anesthesia, of an external fixation system for the treatment of Rolando fractures. Patients and Methods In total, 22 consecutive patients (16 men) underwent surgical treatment for Rolando fractures by using two pairs of pins external fixator. All procedures were performed under local anesthesia (Xylocaine 2%) and an image intensifier. Patients were evaluated at regular intervals postoperatively and contacted by phone for long-term follow-up. Functional outcome was assessed using the validated Quick Disabilities of the Arm, Shoulder, and Hand (Quick DASH) tool. Results The mean age was 39.8 ± 14.2 years. The mean time from injury to surgery was 4.1 ± 2 days. The mean operative time was 16.3 ± 2.6 minutes. All fractures were healed and no loss of fracture reduction was observed postoperatively. One patient developed wound erythema at the proximal pins, without requiring early removal of the implant, and another one experienced temporary numbness at the distribution of the superficial radial nerve. In total, 20 out of the 22 patients who were available for long-term follow-up did not report any complaints and could perform the daily activities without restriction. The average follow-up was 6.5 ± 1.2 years, and the mean Quick DASH score was 1.8 ± 3. Conclusion The two pairs of pins external fixator is a valuable option for the treatment of Rolando fractures and can be easily, quickly, and effectively applied under local anesthesia.
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Affiliation(s)
- Byron E. Chalidis
- 1st Orthopaedic Department, Aristotle University of Thessaloniki School of Medicine, G. Papanikolaou Hospital, Thessaloniki, Greece
| | - Dimitrios Kitridis
- 1st Orthopaedic Department, Aristotle University of Thessaloniki School of Medicine, G. Papanikolaou Hospital, Thessaloniki, Greece
| | - Ioannis Gigis
- 1st Orthopaedic Department, Aristotle University of Thessaloniki School of Medicine, G. Papanikolaou Hospital, Thessaloniki, Greece
| | - Panagiotis K. Givissis
- 1st Orthopaedic Department, Aristotle University of Thessaloniki School of Medicine, G. Papanikolaou Hospital, Thessaloniki, Greece
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Tsai YJ, Yeh JP, Lin TH, Lin TS, Hsieh CH. Hooked embracing plate for Rolando fracture fixation: a preliminary result. BMC Surg 2022; 22:419. [PMID: 36482333 PMCID: PMC9733042 DOI: 10.1186/s12893-022-01876-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 12/02/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Rolando fracture is a comminuted, intra-articular fracture over the metacarpal bone base of the thumb which often leads to joint instability and requirement of surgery. The aim of this study is to evaluate the radiological and functional outcomes of Rolando fracture following surgical fixation with a hooked embracing plate (Acumed, 1.3 mm, Rolando Fracture Hooked Plate) designed for Rolando fracture. METHOD We retrospectively reviewed a consequence of patients between 2018 and 2022 with Rolando fracture who received open reduction internal fixation with hooked embracing plates. Primary endpoints were the quality of radiologic reduction after the operation and peri-operative complications. Secondary outcomes were bone union, pinch and grip strength, palmar abduction, opposition and radiographic osteoarthritis over the trapeziometacarpal (TMC) joint. RESULTS A total of 5 patients were included. All patients had good quality of radiological reduction without peri-operative complications. The opposition, abduction, pinch and grip strength were nearly full-recovered for all patients with fine bone unions after 3 months follow-up. CONCLUSION The hooked embracing plate is a good and safe option for surgical fixation in patients with Rolando fracture. Compared with traditional method such as lag screw or mini-plate fixation, the hooked embracing plate could provide rigid fixation with fine radiologic and functional outcomes with early mobilization.
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Affiliation(s)
- Yueh-Ju Tsai
- grid.413804.aDepartment of Plastic and Reconstructive Surgery, Kaohsiung Chang Gung Memorial Hospital, 123, Dapi Road, Niaosung Dist., Kaohsiung, 83301 Taiwan
| | - Jui-Po Yeh
- grid.413804.aDepartment of Plastic and Reconstructive Surgery, Kaohsiung Chang Gung Memorial Hospital, 123, Dapi Road, Niaosung Dist., Kaohsiung, 83301 Taiwan
| | - Tsen-Hung Lin
- grid.413804.aDepartment of Plastic and Reconstructive Surgery, Kaohsiung Chang Gung Memorial Hospital, 123, Dapi Road, Niaosung Dist., Kaohsiung, 83301 Taiwan
| | - Tsan-Shiun Lin
- grid.413804.aDepartment of Plastic and Reconstructive Surgery, Kaohsiung Chang Gung Memorial Hospital, 123, Dapi Road, Niaosung Dist., Kaohsiung, 83301 Taiwan
| | - Ching-Hua Hsieh
- grid.413804.aDepartment of Plastic and Reconstructive Surgery, Kaohsiung Chang Gung Memorial Hospital, 123, Dapi Road, Niaosung Dist., Kaohsiung, 83301 Taiwan
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Affiliation(s)
- Matthew T Brown
- Fellow in Hand & Wrist Surgery, Hooper Hand Unit, St John's Hospital, Livingston, West Lothian EH54 6PP, United Kingdom.
| | - Philippa A Rust
- Consultant Hand & Wrist Surgeon, Hooper Hand Unit, St John's Hospital, Livingston, West Lothian EH54 6PP, United Kingdom
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Abstract
LEARNING OBJECTIVES After reading this article, the participant should be able to: 1. Understand metacarpal anatomy and its role in fracture pathology. 2. Determine when surgical intervention is needed for metacarpal fractures. 3. Understand the various treatment options for surgical fixation of metacarpal fractures. 4. Describe the role for external fixation in managing difficult metacarpal fractures. BACKGROUND Metacarpal fractures are common injuries that plastic surgeons should be able to evaluate and treat. The goal of this review is to highlight current evidence for managing metacarpal fractures. This Continuing Medical Education article consists of a literature review, illustrations, videos, and an online Continuing Medical Education examination. METHODS The authors reviewed the scientific literature from 2000 to 2015 regarding treatment of metacarpal fractures. Cadaver models were used for instructional videography demonstrating common surgical techniques. Multiple-choice questions were created to review pertinent topics. A discussion and references are provided. RESULTS Numerous treatment options have been described for metacarpal fractures, including splinting, percutaneous fixation, open reduction with internal fixation, and external fixation. All modalities are acceptable strategies for treating metacarpal fractures. The ultimate goal is to maximize hand function with minimal morbidity. CONCLUSIONS A thorough understanding of treatment modalities is helpful in evaluating and managing metacarpal fractures. Although the current literature supports a wide array of treatment strategies, high-level evidence to guide fracture management remains lacking.
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Abstract
Thumb injuries are common in athletes and present a challenging opportunity for upper extremity physicians. Common injuries include metacarpal base fractures (Bennett and Rolando types), ulnar and radial collateral ligament injuries, dislocation of the carpometacarpal and metacarpophalangeal joints, and phalanx fractures. This review, although not exhaustive, highlights some of the most common thumb injuries in athletes. The treating physician must balance pressure from athletes, parents, coaches, and executives to expedite return to play with the long-term well-being of the athlete. Operative treatment may expedite return to play; however, one must carefully weigh the added risks involved with surgical intervention.
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Mumtaz MU, Ahmad F, Kawoosa AA, Hussain I, Wani I. Treatment of Rolando Fractures by Open Reduction and Internal Fixation using Mini T-Plate and Screws. J Hand Microsurg 2016; 8:80-5. [PMID: 27625535 DOI: 10.1055/s-0036-1583300] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 03/15/2016] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Rolando fractures being intra-articular fractures of the most mobile joint of the thumb, assume significance because any residual incongruity of the articular surface may result in loss of motion as well as secondary osteoarthritis and hence serious disability. This fracture continues to pose difficulties to the treating surgeons and although several treatment options have been described for these fractures, there are no definite guidelines. METHODS The present study describes the results of open reduction and internal fixation of nine Rolando fractures with large and single fragments, using mini T-plate and screws. RESULTS At 3-year follow-up all the fractures had united, functional results were excellent or good in most cases, and all the patients had returned to previous activities. Significant complications such as deep infection and loss of reduction were not encountered in any patient. CONCLUSION Open reduction and internal fixation with mini T-plates in properly selected cases of Rolando fracture with large and single palmar and dorsal articular fragments offers several advantages such as allowing direct visualization of the joint, removal of interposed soft tissues, and exact anatomical restoration of the articular surface. The fixation in most cases is rigid enough to allow early mobilization without loss of reduction. Thus, complications such as stiffness as well as future arthrosis may be minimized. However, the technique is demanding and needs high degree of precision. The possibility of implant removal should be discussed beforehand with the patient.
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Affiliation(s)
- Mohammad Umar Mumtaz
- Department of Orthopaedics, Government Hospital for Bone and Joint Surgery, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Fiaz Ahmad
- Department of Orthopaedics, Government Hospital for Bone and Joint Surgery, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Altaf Ahmad Kawoosa
- Department of Orthopaedics, Government Hospital for Bone and Joint Surgery, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Imtiyaz Hussain
- Department of Orthopaedics, Government Hospital for Bone and Joint Surgery, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Iftikhar Wani
- Department of Orthopaedics, Government Hospital for Bone and Joint Surgery, Government Medical College, Srinagar, Jammu and Kashmir, India
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Xing SG, Tang JB. Surgical Treatment, Hardware Removal, and the Wide-Awake Approach for Metacarpal Fractures. Clin Plast Surg 2014; 41:463-80. [DOI: 10.1016/j.cps.2014.03.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Greeven APA, Hammer S, Deruiter MC, Schipper IB. Accuracy of fluoroscopy in the treatment of intra-articular thumb metacarpal fractures. J Hand Surg Eur Vol 2013. [PMID: 23186860 DOI: 10.1177/1753193412468565] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to determine the accuracy of fluoroscopic imaging during closed reduction and percutaneous fixation of intra-articular thumb metacarpal fractures. Closed reduction and percutaneous fixation was assessed in eight simulated intra-articular thumb metacarpal fractures, using fluoroscopy and digital radiographs. Displacement and fracture step-off were measured during fluoroscopy, on plain radiographs, and by direct visualization after careful dissection. Displacement on fluoroscopy was 0.8 (SD 1.0) mm and 1.2 (SD 1.4) with radiographic imaging. Direct visualization showed displacement of 0.9 (SD 1.2) mm. Intra-articular step-off on fluoroscopy was 0.8 (SD 1.0) mm and 0.8 (SD 0.8) with radiographic imaging. Direct visualization showed an intra-articular step-off of 0.8 (SD 1.2) mm. Statistical analysis showed excellent compatibility between fluoroscopy and direct visualization. Fluoroscopic visualization during surgery provides an adequate assessment of articular step-off and displacement in comparison with radiographs and direct visualization.
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Affiliation(s)
- A P A Greeven
- Department of Surgery and Traumatology, Leiden University Medical Centre, Leiden, The Netherlands
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Abstract
Fractures of the hand are common injuries and in particular, fractures involving the articular surfaces can present difficulties to the orthopedic surgeon in practice. Although the treatment of these fractures needs to be individualized based on fracture pattern and location, the goals for these fractures are to restore the alignment, stability, and congruity and to allow for early motion to prevent stiffness and traumatic arthritis. This article classifies the various types of intra-articular hand fractures as well as the workup and management of these injuries.
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Affiliation(s)
- Nikhil Oak
- Department of Orthopaedic Surgery, University of Michigan, 1500 East Medical Center Drive, 2912 Taubman Center, Ann Arbor, MI 48109, USA
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Houshian S, Jing SS. Treatment of Rolando fracture by capsuloligamentotaxis using mini external fixator: a report of 16 cases. HAND SURGERY : AN INTERNATIONAL JOURNAL DEVOTED TO HAND AND UPPER LIMB SURGERY AND RELATED RESEARCH : JOURNAL OF THE ASIA-PACIFIC FEDERATION OF SOCIETIES FOR SURGERY OF THE HAND 2013; 18:73-8. [PMID: 23413855 DOI: 10.1142/s0218810413500147] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Treatment of Rolando fractures remains a challenge for hand surgeons. We present a case series of 16 comminuted Rolando type fractures treated by controlled capsuloligamentous distraction (and over distraction by 2 mm) using the Pennig mini-external fixation system. Additional Kirschner wire(s) were used to maintain fracture reduction and stability. Average time of injury to surgery time was five days. Mean age of patients was 26 years. The mean follow-up was 20 months. Excellent fracture union was achieved in all cases. All except two patients were pain free at the final consultation. The mean grip and pinch strength of the affected thumb was 96% and 93%, respectively, of the unaffected thumb with a minimal loss of movements. This technique is simple and effective. It enables immediate mobilisation of the unaffected joints and prevents stiffness. We recommend this distraction technique for the treatment of significantly comminuted Rolando type fractures.
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Affiliation(s)
- Shirzad Houshian
- Department of Orthopaedics, Queen Hospital, Romford Valley Way Romford, Essex RM7 O AG, UK.
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Marsland D, Sanghrajka AP, Goldie B. Static monolateral external fixation for the Rolando fracture: a simple solution for a complex fracture. Ann R Coll Surg Engl 2012; 94:112-5. [PMID: 22391382 DOI: 10.1308/003588412x13171221501140] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Rolando fractures are often difficult to manage because of their inherent instability. We describe a simple technique for the treatment of this fracture using the principle of ligamentotaxis, with a static, two-pin external fixator spanning the trapeziometacarpal joint, and present the results of a single-surgeon case series. METHODS Eight consecutive patients (mean age: 32.8 years) with Rolando fractures were treated using a Hoffmann II(®) Micro small bone external fixator using blunt ended 2.0mm half pins, inserted into the trapezium and diaphysis of the first metacarpal. Functional outcome was assessed with the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score at a mean time of 2.7 years following the fracture (range: 4 months-6.0 years). The mean time to frame removal was 28 days. RESULTS There were three cases of superficial pin site infection. Follow-up x-rays at four months did not demonstrate significant joint incongruity or malunion in any case. The mean QuickDASH score was 7.95 and all patients returned to their previous levels of activity. CONCLUSIONS Although external fixation risks pin site infection, the results of this study support the use of spanning trapeziometacarpal external fixation for Rolando fractures as it reliably gives excellent functional outcomes.
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Affiliation(s)
- D Marsland
- Whipps Cross University Hospital, London, UK.
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Carlsen BT, Moran SL. Thumb trauma: Bennett fractures, Rolando fractures, and ulnar collateral ligament injuries. J Hand Surg Am 2009; 34:945-52. [PMID: 19411003 DOI: 10.1016/j.jhsa.2009.03.017] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2009] [Accepted: 03/23/2009] [Indexed: 02/02/2023]
Abstract
Injuries to the thumb are predominated by fractures of the proximal phalanx, ligamentous injuries about the metacarpophalangeal joint, and metacarpal base fractures. This article will attempt to summarize recent advancements within the realm of thumb trauma, with particular attention to Bennett fractures, Rolando fractures, and ulnar collateral ligament injuries.
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El-Sharkawy AA, El-Mofty AO, Moharram AN, Abou Elatta MM, Asal F. Management of Rolando fracture by modified dynamic external fixation: a new technique. Tech Hand Up Extrem Surg 2009; 13:11-15. [PMID: 19276920 DOI: 10.1097/bth.0b013e3181847652] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Rolando fracture is one of the most difficult fractures facing hand surgeons. It can be described as a Y- or T-shaped fracture line that runs longitudinally through the metaphyseal area, with an intra-articular fracture splitting the metacarpal base fragment into a volar and a dorsal fragment. In this study, we introduce our technique used in the management of 7 cases, which were treated by our dynamic external fixation. The results were found to be promising, with an excellent range of motion and power grip postoperative. The joints spaces were restored. No patients in our series developed arthritic changes. All patients are pain free in 3 months.
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Demir E, Unglaub F, Wittemann M, Germann G, Sauerbier M. Osteosynthetisch versorgte intraartikuläre Frakturen der Metakarpale-I-Basis. Unfallchirurg 2006; 109:13-21. [PMID: 16133289 DOI: 10.1007/s00113-005-0988-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Fractures of the thumb metacarpal occur quite frequently at the base. Intra-articular metacarpal base fractures (such as Bennett or Rolando fractures) present treatment challenges and surgical therapy remains controversial. Malunion of these fractures may lead to the development of painful osteoarthrosis at the trapeziometacarpal joint which can seriously impair overall hand function. PATIENTS AND METHODS In a retrospective analysis, 30 intra-articular fractures (24 Bennett's, three Rolando's and three comminuted fractures) treated between 1994 and 1999 in the Department of Hand, Plastic and Reconstructive Surgery in Ludwigshafen have been reviewed. A total of 25 patients (83%) could be examined clinically and radiologically at an average follow-up of 39 months. The subjective outcome was measured using the DASH-questionnaire. Clinical examination included grip strength and range of motion measurements. RESULTS Four cases were treated with percutaneous pinning, in 26 cases open reduction with internal fixation was performed. Radiological analysis demonstrated good reduction in 90% of all cases (metacarpal base gap/step-off in articular surface: <1 mm in 63%, between 1-2 mm in 27%, >2 mm in 10%). Twelve patients (48%) were free of symptoms at follow-up. Slight restricted flexion was noted in 11 (44%) patients (75-90% of healthy collateral values), including one patient with moderate opposition deficit (<75% of uninjured value). Three patients (12%) demonstrated weakness in tip pinch and one patient had decreased key pinch compared to the uninjured hand. Overall, good functional results for radial abduction, flexion and opposition as well as good grip strength compared to their uninjured side were found. At follow-up a total of 64% radiological features of trapeziometacarpal arthrosis have been documented. Very low impairment rates in the DASH-scores of all three parts (below 9 points) were measured. There was no correlation between the quality of thumb base restoration and radiological or subjective outcome. CONCLUSION Exact anatomical restoration of the articular surface may not be essential for obtaining satisfactory functional results.
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Affiliation(s)
- E Demir
- Klinik für Plastische Chirurgie, Hand- und Verbrennungschirurgie, Universitätsklinikum RWTH Aachen.
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Abstract
Abraham Colles had the good fortune to describe the most common fracture about the wrist but, because its description was published in a provincial journal, it received little attention and was almost never referred to in his lifetime. The same can be said of Claude Pouteau who described the same fracture in another lesser-known medical journal. Robert Smith described the fracture that bears his name in 1847 although it had already been described by Jean-Gaspar-Blaise Goyrand some years before. Galeazzi's fracture had been described nearly 90 years earlier by Sir Astley Cooper and is also known as Dupuytren's and Piedmont fracture. To add to the conflicting nomenclature it is sometimes not clear whether a Smith's II fracture is a Barton's fracture or a reversed Barton's fracture. In the presence of all of this confusion it is not surprising that a Swiss group, Arbeitsgemeinschaft für Osteosynthesefragen, has classified wrist fractures into groups of As, Bs and Cs.
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Affiliation(s)
- Alan J Thurston
- Department of Surgery and Anaesthesia, Wellington School of Medicine, Wellington South, New Zealand.
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Rizzo M, Levin LS. Hand Surgery. Surgery 2001. [DOI: 10.1007/978-3-642-57282-1_92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hunter TB, Peltier LF, Lund PJ. Radiologic history exhibit. Musculoskeletal eponyms: who are those guys? Radiographics 2000; 20:819-36. [PMID: 10835130 DOI: 10.1148/radiographics.20.3.g00ma20819] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- T B Hunter
- Department of Radiology, University of Arizona, 1501 N Campbell Ave, Tucson, AZ 85724-5067, USA
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Abstract
Fractures of the thumb metacarpal occur most frequently at the base. These fractures can be subdivided into intra-articular and extra-articular types. Intra-articular fractures present treatment challenges because they have a tendency to displace due to deforming forces acting at the base of the thumb. An understanding of the anatomy, biomechanics, and fracture pattern will aid in deciding on the best treatment option for each fracture type. Surgical treatment is recommended for unstable fractures. Anatomic restoration of the articular surface in Bennett and Rolando fractures is not essential to obtain a good functional result. However, reduction should be 1 mm or less to reduce the risk of radiographic arthritis. Malunion of these fractures may result in long-term disability. Closed reduction and percutaneous Kirschner-wire fixation is generally the appropriate treatment for a Bennett fracture. Rolando fractures can be treated with either open reduction and internal fixation or external fixation, depending on the size of the fracture fragments. In the case of severely comminuted intra-articular fractures, articular impaction has been implicated as one of the causes of posttraumatic arthritis. It is difficult to restore the articular surface in these injuries. Therefore, external fixation can be considered when the fracture fragments are small and there is significant soft-tissue injury.
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Kontakis GM, Katonis PG, Steriopoulos KA. Rolando's fracture treated by closed reduction and external fixation. Arch Orthop Trauma Surg 1998; 117:84-5. [PMID: 9457345 DOI: 10.1007/bf00703448] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In 11 patients with a Rolando's fracture of the first metacarpal, the mini-Hoffman external fixation was used to maintain closed reduction of the fracture, with two pins placed distally in the first metacarpal and one pin proximally in the trapezium. The results were excellent in 7 patients; in 3 patients mild arthritis was noted radiographically, and one patient had a poor result because of severe postraumatic arthritis 1-5 years (mean 30 months) after the injury. This method of treatment is proposed for patients with Rolando's fracture as it is very easily performed and provides good results.
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Affiliation(s)
- G M Kontakis
- Department of Orthopaedics-Traumatology, University of Crete, Heraklion, Crete
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Brazier J, Moughabghab M, Migaud H, Fontaine C, Elia A, Tillie B. [Articular fractures of the base of the first metacarpal. Comparative study of direct osteosynthesis and closed pinning]. ANNALES DE CHIRURGIE DE LA MAIN ET DU MEMBRE SUPERIEUR : ORGANE OFFICIEL DES SOCIETES DE CHIRURGIE DE LA MAIN = ANNALS OF HAND AND UPPER LIMB SURGERY 1996; 15:91-9. [PMID: 8845274 DOI: 10.1016/s0753-9053(96)80014-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The authors retrospectively studied 35 articular fractures of the base of the first metacarpal, with an average follow-up of 3 years. Treatment consisted of closed reduction and pinning in 19 cases, open reduction and rigid fixation in 16 cases. Results were estimated in terms of pain, range of movement (flexion-adduction arc and abduction-extension arc), strength and X-rays. There was no significant difference between the two groups, for age, sex, occupation, side and postoperative care. Only one significant difference between both procedures was found: flexion-adduction was better after osteosynthesis than after closed pinning (p = 0.03). The authors observed a better range of flexion-adduction and pinch strength after treatment of Bennett's fracture. Radiographic features were not different at follow-up between open and closed osteosynthesis.
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Affiliation(s)
- J Brazier
- Service de Chirurgie Orthopédique et Traumatologique, Hôpital B, CHRU Lille
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Kjaer-Petersen K, Jurik AG, Petersen LK. Intra-articular fractures at the base of the fifth metacarpal. A clinical and radiographical study of 64 cases. JOURNAL OF HAND SURGERY (EDINBURGH, SCOTLAND) 1992; 17:144-7. [PMID: 1588193 DOI: 10.1016/0266-7681(92)90075-d] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The treatment of 64 intra-articular fractures at the base of the fifth metacarpal was studied. 11 fractures with minimal displacement had been immobilised in a plaster cast without reduction. The position was improved in five of 25 fractures treated by closed reduction and a plaster cast, six of nine fractures after percutaneous pinning, and 12 of 19 fractures after open reduction and internal fixation. At follow-up after a median of 4.3 years, 19 of 50 patients answering a questionnaire had intermittent pain, especially on firm grip. 43 patients were re-examined clinically and radiographically: 21 (49%) had decreased grip power, and 28 had radiographical signs of osteoarthrosis.
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Affiliation(s)
- K Kjaer-Petersen
- University Department of Orthopaedic Surgery, University of Aarhus, Denmark
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