Thumb fracture: Difference between revisions

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==Background==
==Background==
===Classification===
{{Thumb fracture classification}}
* Type I ([[Bennett's Fracture]])
** Fx-dislocation of the base of the metacarpal (intraarticular)
* Type II (Rolando's Fx)
** Comminuted version of a Bennett's fracture (intraarticular)
* Type III
** Extraarticular (transverse or oblique)
* Type IV
** Extraarticular pediatric fx involving the proximal physis


==Diagnosis==
==Clinical Features==
*Examination
*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 (Game Keeper's Thumb)
* Imaging
** AP, lateral, oblique


==Treatment==
==Differential Diagnosis==
* Splinting
{{Hand and finger fractures DDX}}
** 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]] extening to the IP joint and wrist in 30 deg of extension
==Evaluation==
* RICE
[[File:Bennetts Fracture.jpg|thumb|Bennett's fracture]]
** 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)
*Imaging plain films
* Reduction
**AP, lateral, oblique
** Indicated for:
 
*** Angulated extraarticular fx if clinician is comfortable with the procedure
==Management==
*[[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 (more than 20-30 degrees), extraarticular fracture if clinician is comfortable with the procedure<ref name="Hand and wrist emergencies">German C. Hand and wrist emergencies. In: Bond M, ed. Orthopedic Emergencies: Expert Management for the Emergency Physician. Cambridge: Cambridge University Press; October 31, 2013.</ref>


==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==
*[[Hand and finger fractures]]
*[[Hand and finger fractures]]


==Source==
==References==
UpToDate
<references/>


[[Category:Ortho]]
[[Category:Orthopedics]]

Revision as of 11:11, 16 October 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

Evaluation

Bennett's fracture
  • Imaging plain films
    • AP, lateral, oblique

Management

  • 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 (more than 20-30 degrees), extraarticular fracture if clinician is comfortable with the procedure[1]

Disposition

  • Refer within 3-5 days:
    • All intraarticular fractures warrant referral (most require surgery)
    • Extraarticular fractures that cannot be adequately reduced

See Also

References

  1. German C. Hand and wrist emergencies. In: Bond M, ed. Orthopedic Emergencies: Expert Management for the Emergency Physician. Cambridge: Cambridge University Press; October 31, 2013.