Thumb fracture: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
* Important to distinguish tenderness at base of 1st MC from injury to scaphoid, trapezium, or distal radius | *Important to distinguish tenderness at base of 1st MC from injury to scaphoid, trapezium, or distal radius | ||
* If pain or ecchymosis occurs more distally at the MCP (particularly on the ulnar side) consider ulnar collateral ligament injury ([[Gamekeeper's Thumb]]) | *If pain or ecchymosis occurs more distally at the MCP (particularly on the ulnar side) consider ulnar collateral ligament injury ([[Gamekeeper's Thumb]]) | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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==Diagnosis== | ==Diagnosis== | ||
[[File:Bennetts Fracture.jpg|thumb|Bennett's fracture]] | [[File:Bennetts Fracture.jpg|thumb|Bennett's fracture]] | ||
* Imaging plain films | *Imaging plain films | ||
** AP, lateral, oblique | **AP, lateral, oblique | ||
==Treatment== | ==Treatment== | ||
* [[Splinting]] | *[[Splinting]] | ||
** Type I, II - [[Thumb Spica Splint]] with the IP joint free and wrist in 30 deg of extension | **Type I, II - [[Thumb Spica Splint]] with the IP joint free and wrist in 30 deg of extension | ||
** Type III - Short arm [[Thumb Spica Splint]] extending to the IP joint and wrist in 30 deg of extension | **Type III - Short arm [[Thumb Spica Splint]] extending to the IP joint and wrist in 30 deg of extension | ||
* RICE | *RICE | ||
** Significant swelling or overly aggressive icing to radial side of thumb may result in temporary palsy to the superficial radial nerve (numbness over the dorsum of the thumb) | **Significant swelling or overly aggressive icing to radial side of thumb may result in temporary palsy to the superficial radial nerve (numbness over the dorsum of the thumb) | ||
* Reduction | *Reduction | ||
** Indicated for angulated, extraarticular fracture if clinician is comfortable with the procedure | **Indicated for angulated, extraarticular fracture if clinician is comfortable with the procedure | ||
==Disposition== | ==Disposition== | ||
* Refer within 3-5 days: | *Refer within 3-5 days: | ||
** All intraarticular fractures warrant referral (most require surgery) | **All intraarticular fractures warrant referral (most require surgery) | ||
** Extraarticular fractures that cannot be adequately reduced | **Extraarticular fractures that cannot be adequately reduced | ||
==See Also== | ==See Also== | ||
Revision as of 19:48, 4 July 2016
Background
Thumb fracture classification
- Type I (Bennett's fracture)
- Fracture-dislocation of the base of the metacarpal (intra-articular)
- Base fragment is aligned with trapezium, but distal portion is subluxed by abductor pollicis longus
- Most common type of thumb fracture; nearly always accompanied by some subluxation or dislocation of CMC
- Type II (Rolando's fracture)
- Comminuted version of a Bennett's fracture (intra-articular)
- Type III
- Extra-articular (transverse or oblique)
- Type IV
- Extra-articular pediatric fracture involving the proximal physis
Clinical Features
- Important to distinguish tenderness at base of 1st MC from injury to scaphoid, trapezium, or distal radius
- If pain or ecchymosis occurs more distally at the MCP (particularly on the ulnar side) consider ulnar collateral ligament injury (Gamekeeper's Thumb)
Differential Diagnosis
Hand and Finger Fracture Types
Diagnosis
- Imaging plain films
- AP, lateral, oblique
Treatment
- Splinting
- Type I, II - Thumb Spica Splint with the IP joint free and wrist in 30 deg of extension
- Type III - Short arm Thumb Spica Splint extending to the IP joint and wrist in 30 deg of extension
- RICE
- Significant swelling or overly aggressive icing to radial side of thumb may result in temporary palsy to the superficial radial nerve (numbness over the dorsum of the thumb)
- Reduction
- Indicated for angulated, extraarticular fracture if clinician is comfortable with the procedure
Disposition
- Refer within 3-5 days:
- All intraarticular fractures warrant referral (most require surgery)
- Extraarticular fractures that cannot be adequately reduced
See Also
References
www.orthobullets.com