Rolando Fracture
A Rolando Fracture is a fracture to the base of the 1st metacarpal where it joins the carpal bones (1st CMC joint), between the thumb and the wrist. This is similar to the Bennett fracture, although it is harder to treat.
Symptoms of a Rolando Fracture
- Immediate severe pain at the thumb side of the wrist.
- Rapid swelling.
- Difficulty and severe pain when trying to move the thumb.
- The thumb may appear deformed.
The difference between a Rolando fracture and a Bennett fracture is that with a Rolando fracture the base of the metatarsal is fractured into 2 or 3 fragments (occasionally more). This is known as a T or Y shaped fracture due to its appearance.
Treatment
Treatment of a Rolando fracture is difficult, as it is important to ensure that all three fragments are aligned and that the shaped of the joint surface is maintained. Surgery is almost always required.
The procedure involves realigning the bone fragments and then fixing them with either internal wires or pins, or an external frame and pins. The joint is then immobilised in a thumb spica cast (where the thumb is kept separate from the hand) for 4-6 weeks.
When the cast is removed, the patient is referred to a physiotherapist (or similar) who will help mobilise the joint as well as giving some home exercises for strength and mobility.
When getting back to sport, the use of a protective thumb splint or support is recommended.
