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Rolando Fracture

synonyms:

Rolando Fracture ICD-9

  • 815.01 (closed fracture base of thumb metacarpal)
  • 815.11 (open fracture base of thumb metacarpal)
  • 815.00 (closed metacarpal fracture; unspecified)

Rolando Fracture Etiology / Epidemiology / Natural History

  • Pilon type fracture of the thumb metacarpal base usually into T or Y configurations.
  • Generally results from axial loads.

Rolando Fracture Anatomy

  • Abductor pollicis longus and adductor pollicis displace the metacarpal radially and proximally.
  • Anterior oblique ligament remains attached to fracture fragment.

Rolando Fracture Clinical Evaluation

  • Pain, swelling, ecchymosis at the thumb MC base.
  • Document neurovascular exam.

Rolando Fracture Xray / Diagnositc Tests

  • P/A, lateral and oblique views of the thumb.
  • True lateral view: palmar surface of the hand is placed flat on cassette; hand and wrist are pronated 15°-35° . Tube directed obliquely 15°distal-to-proximal, centered over the trapeziometacarpal joint (Billing L, Acta Radiol1952; 38:471).
  • CT: consider for pre-operative eval of comminution.

Rolando Fracture Classification / Treatment

  • 3-part Rolando fracture: ORIF with multiple Kirschner pins or plate +/-bone graft.
  • Severe comminution: External fixation with ligamentotaxis reduction of displaced fragments +/- articular reduction with Kirschner pins

Rolando Fracture Associated Injuries / Differential Diagnosis

Rolando Fracture Complications

  • Infection
  • Malunion
  • Arthritis
  • Stiffness / Contracture
  • Nonunion
  • Pain
  • Painful hardware

Rolando Fracture Follow-up Care

  • Post-op: Thumb spica splint, elevation, NWB
  • 7-10 Days: Wound check, Thumb spica cast
  • 6 Weeks: K-wire removal, begin ROM exercises provided union is evident on xray.
  • 3 Months: Evaluated ROM. Sport specific rehab.
  • 6 Months:
  • 1Yr: f/u xrays, Assess outcome. Consider trapeziometacarpal arthrodesis for persistant pain with radiographic evidence of articular incongruity.

Rolando Fracture Review References

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