A Rolando Fracture is a fracture to the base of the 1st metacarpal where it joins the carpal bones between the thumb and the wrist. This is similar to the Bennett fracture, although a little more complex to treat as the metacarpal is fractured into several pieces. This causes considerable thumb and wrist pain, with surgery nearly always needed.
A Rolando fracture will most likely be caused by a sudden impact or trauma such as punching something hard. The patient will feel immediate severe pain on the thumb side of the wrist. There will be rapid swelling and bruising may appear. The thumb may appear deformed depending on the level of bone displacement and the patient will experience great difficulty and a high level of pain when trying to move the thumb.
The difference between a Rolando fracture and a Bennett fracture is that with a Rolando fracture the base of the metacarpal is fractured into 2 or 3 fragments (occasionally more). This is known as a T or Y shaped fracture due to its appearance.
Treatment of a Rolando fracture
Surgery is almost always required. It is essential the all the bone fragments are put back in place and pinned or screwed if needed.
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 immobilized in a thumb spica cast (where the thumb is kept separate from the hand) for 4 to 6 weeks.
When the cast is removed, the patient is referred to a physiotherapist, physical therapist or similar who will help mobilize the joint as well as giving some home exercises for strength and mobility. When getting back to the sport, the use of a protective thumb splint or support is recommended.
Rolando Fracture surgery
Mr. Elliot Sorene MBBS FRCS (Tr & Orth) EDHS Consultant Orthopaedic, Hand & Upper Limb Surgeon talks about surgery for a Rolando Fracture.
Both a Rolando fracture and Bennett's fracture are unstable fractures at the base of the thumb.
They are seen a lot in rugby players and other contact sports. The Bennett is not a complex fracture as a Rolando fracture where more than just one piece of bone pops out at the bottom. The Bennett's fracture is a simpler fracture where a number only one piece of the bone is displaced.
These fractures can be extremely difficult to treat conservatively (without surgery) unless the bones have not moved at all. If the bones are displaced then this type of fracture will require surgery and fixation of the bones.
There are however a number of modern methods to treat these injuries surgically. The Rolando fracture can be operated on with locking plates and small screws which hold the fracture fragments in place. A simpler Bennett fracture can be wired but whatever the surgery these injuries will require a full rehabilitation and exercise program to restore mobility and strength.
Following surgery, the wrist may be in plaster for a period of 6 weeks or possibly using a removable splint rather than a fixed plaster cast. Eventually, if the bones are restored to their correct positions the patient will get a good result and restore decent function to the wrist.