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Techniques for fixation of bennett and rolando fractures
Indications
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Closed reduction and percutaneous pinning is indicated for any Bennett or Rolando fracture with articular step-off greater than 1 mm, fracture-dislocation of the thumb carpometacarpal (CMC) joint, or angulation/rotation greater than 10 degrees.
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Open reduction with internal fixation is indicated for open fractures of the thumb CMC or fractures that cannot be reduced via closed methods.
Contraindications
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The integrity of the thumb CMC joint is vital for normal thumb/hand function. Therefore there are few contraindications to reduction and fixation of displaced Bennett and Rolando fractures.
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Internal fixation should be avoided in open injuries with soft-tissue loss, unless coverage can be provided acutely. In this scenario, percutaneous pinning is chosen for ease of hardware removal should a wound healing issue or infection arise.
Clinical examination
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Swelling and tenderness are present on the proximal part of the thumb metacarpal ( Fig. 18.1 ).
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The thumb may appear shortened because of subluxation or dislocation of the CMC joint or because of fracture comminution.
Imaging
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A true thumb posteroanterior (PA) view (Robert’s view) and lateral view (Bett’s view) are needed ( Fig. 18.2 ).
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For a true PA view of the thumb CMC, the shoulder, forearm, and hand must be internally rotated and hypersupinated so that the thumb lays flat against the cassette/image sensor.
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Computed tomography is rarely needed but can help with the assessment of fracture comminution and joint congruity in complex cases.
Surgical anatomy
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