Rolando Fracture: Diagnosis and Treatment

Rolando fracture is similar to Bennett Fracture (read this first) except for the fact that

• it is less common
• bone is fractured into three or more pieces

It has also been described as a T or Y shaped fracture of the first metacarpal base.

Symptoms are similar to Bennett fracture.

Diagnosis is by x ray of the thumb.

Treatment of this fracture is difficult. As the joint surface is involved in the fracture hence restoration of accurate joint congruity is of utmost importance.

Methods of treatment include

• traction (to align the fractured fragments) followed by plaster cast application
• external fixation (after traction a external frame is applied to hold the fragments)
• internal fixation with plate and screws (surgical incision is given and the fracture is reduced under direct vision)
• wilful neglect (plaster is applied till pain and swelling subside after which active use of the hand is encouraged)

Internal fixation should only be undertaken by a experienced hand surgeon.

Wilful neglect should only be undertaken when there is no hope for adequate alignment of the fracture, (four to five bone fragments) even with internal fixation.

The fracture usually unites in three to four weeks after which active physiotherapy is started.

Frequently Asked Questions

Will I regain adequate function of my thumb after this fracture?

Adequate function after the fracture depends upon

• number of fracture fragments (more the fragments poorer the function)
• adequate restoration of joint alignment
• presence of pre-existing osteoarthritis of the joint

The joint involved in this fracture is a common site of osteoarthritis and the presence of osteoarthritis, can result in poor functional out come.

Hand Injury

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