IS case 541: Rolando fracture; comminuted intra-articular fracture of the 1st metacarpal
Imaging Sciences URMC 2010
Publication Date: 2010-09-17
History
Patient is a 36-year-old male who injured his thumb in a snowmobile accident. He had no previous trauma and now presents with pain in his left thumb.
Findings
Plain radiographs of the hand and 1st digit/thumb were obtained at initial presentation to the emergency department. Images demonstrated comminuted intra-articular fracture of the base of the 1st metacarpophalangeal joint with slight proximal distraction of radial fracture fragment. This is the classic appearance of a Rolando fracture.
Diagnosis
Rolando fracture; comminuted intra-articular fracture of the 1st metacarpal
Discussion
Named after Italian surgeon Silvia Rolando and first described in 1910, the eponymous fracture is a comminuted intra-articular fracture of the base of the first metacarpal and may be thought of as a comminuted version of the more commonly encountered Bennett fracture. As in the Bennett fracture, the fragment of the radial margin of the proximal metacarpal is often dorsally and radially distracted due to attachment of the abductor pollicis longus. Mechanism is usually axial loading or blow to partially flexed metacarpophalangeal joint, e.g. in a fist fight.
The fracture lucency often assumes a "T", "V", or "Y" configuration; although not performed in this instance, additional characterization with multiplanar computed tomography of the fracture may be considered in patients with more severely comminuted fractures in order to identify smaller intra-articular fragments which may not be clearly evident in plain radiography.
Due to the greater degree of comminution and the increased technical difficulty in reapproximating the articular surfaces in an anatomic fashion, the prognosis is worse than in a Bennett fracture despite surgical intervention. Highly comminuted fractures without fragments large enough for hardware insertion are treated with immobilization alone.
References
- Greenspan A. Orthopedic Imaging: A Practical Approach, 4th ed. Philadelphia: Lippincott Williams & Wilkins, 2004.
- Dahnert WF. Radiology Review Manual, 6th ed. Lippincott Williams & Wilkins, 2007.
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