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synonyms:Rolando fracture, thumb metacarpal base fracture
Rolando Fracture ICD-10
- S62.224A Nondisplaced Rolando's fracture, right hand, initial closed
- S62.225A Nondisplaced Rolando's fracture, left hand, initial closed
- S62.226A Nondisplaced Rolando's fracture, unspecified hand, initial closed
- S62.221A Displaced Rolando's fracture, right hand, initial closed
- S62.222A Displaced Rolando's fracture, left hand, initial closed
- S62.223A Displaced Rolando's fracture, unspecified hand, initial closed
- see All Rolando's Fracture codes.
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
- Greens Hand Surgery
- Rockwood and Green's Fractures in Adults 6th ed, 2006
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