Rolando's fracture

Rolando's fracture is a type of fracture of the thumb that involves a comminuted intra-articular fracture at the base of the first metacarpal bone. This injury is less common than the similar Bennett's fracture, which is a two-piece fracture dislocation also at the base of the first metacarpal. Rolando's fracture is characterized by its Y- or T-shaped break, involving the metacarpal base and extending into the carpometacarpal joint, leading to a more complex injury compared to Bennett's fracture. The fracture is named after Silvio Rolando, who first described it in the early 20th century.

Causes

Rolando's fracture typically results from a forceful axial load or direct trauma to the thumb, such as a fall onto an outstretched hand or a direct blow. This type of injury is common in sports, physical altercations, and accidents where the thumb is subjected to high impact or stress.

Symptoms

Patients with Rolando's fracture often present with pain, swelling, and limited mobility in the affected thumb. Visible deformity and bruising may also be present, depending on the severity of the fracture and the extent of soft tissue injury.

Diagnosis

Diagnosis of Rolando's fracture involves a thorough clinical examination followed by imaging studies. X-rays of the hand are the primary diagnostic tool, typically showing a Y- or T-shaped fracture pattern at the base of the first metacarpal. In some cases, CT scans may be necessary to fully assess the extent of the fracture and plan for surgical intervention.

Treatment

The treatment of Rolando's fracture depends on the severity and complexity of the fracture. Non-displaced or minimally displaced fractures can sometimes be managed conservatively with immobilization in a cast or splint for several weeks. However, due to the intra-articular nature and the typical displacement of these fractures, surgical intervention is often required. Surgery aims to realign the fractured fragments and stabilize them, usually with the use of pins, screws, or plates. Post-operative care includes immobilization, followed by a period of physical therapy to restore function and range of motion.

Prognosis

The prognosis for Rolando's fracture varies depending on the severity of the fracture and the effectiveness of treatment. While surgical treatment can lead to good functional outcomes, complications such as arthritis, stiffness, and reduced grip strength may occur, especially in more complex or inadequately treated cases.

Prevention

Preventing Rolando's fracture involves minimizing the risk of thumb injury through the use of protective gear during high-risk activities, proper technique in sports and physical activities, and general safety measures to avoid falls and direct trauma to the hand.