HWN Suggests

Who is Rolando Bennett?

Could you imagine going through life without working thumbs? 80% of thumb fractures involve the metacarpal base. Bennett and Rolando fractures are associated with a high risk of early arthritis and mechanical limitations, especially if reduced inappropriately.

Usually caused by axial force applied to the flexed thumb. Patients will experience pain at the base of the thumb, with possible swelling, ecchymosis and tenderness to the area, and worsened pain with range of motion. For all suspected thumb fractures, get dedicated thumb Xrays, but if you see normal Xrays and still have a high clinical suspicion for injury, get a true AP view of the thumb (AKA Roberts view).

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Articles of Interest

Base of Thumb Fractures

Base of Thumb metacarpal fractures can be extra-articular fractures, Bennett fractures (partial intra-articular), or Rolando fractures (complete intra-articular).

Bennett fracture

Thumb metacarpal fractures are rare because of the thumb’s inherent mobility. However, when fractures do occur they usually involve the base — and the Bennett fracture is the most common type. The Bennett fracture usually results from axial loading onto a partially flex thumb metacarpal. This can occur when a fist strikes a solid object.

Bennett's Fracture and other Thumb Injuries

Identifying and treating thumb injuries is extremely important. Thumb function constitutes 50% of hand function as a whole.

Bennett’s Fracture Management: A Systematic Review of Literature

Bennett’s fracture is a relatively common fracture of the base of the thumb with no consensus on optimum management. Determining the optimal treatment method for Bennett’s fractures remain a challenge and has been the subject of much debate.

First (thumb) metacarpal fractures

Metacarpal fractures are common. They account for 30 to 40 percent of all hand fractures. First metacarpal (thumb) fractures make up almost 25 percent of all metacarpal fractures, placing them second only to fifth metacarpal neck (ie, "boxers") fractures in terms of frequency. Of the fractures of the first metacarpal, over 80 percent involve the base.

Rolando fracture

Rolando fractures are associated with poor prognosis and when they occur on the dominant hand potential for disability is even greater. Timely imaging, placement into a thumb spica splint, and orthopedic surgery evaluation are integral to ensuring the best possible outcome for the patient.

Thumb Base Fractures

The majority of displaced Bennett fractures and almost all Rolando fractures require surgery, with closed reduction and percutaneous Kirschner wire fixation...

Resources

Thumb Spica Splint

This video has been provided by Emergency Procedures App developers (Dr John Mackenzie and Dr James Miers) in order to help medical students, interns in training.

OrthoInfo

The most common of these in the thumb are fractures involving the base of the first metacarpal, affecting the CMC joint where the thumb connects to the wrist: A Bennett fracture is a fracture at the base of the thumb metacarpal involving the CMC joint, resulting in a clean break with a sizeable piece of bone broken off. A Rolando fracture is similar to a Bennett fracture, except that instead of a clean break, the bone is shattered into several pieces.