Thumb fracture

Background

Classification

• Type I (Bennett's Fx)
  • 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

• Examination
  • 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 (Game Keeper's Thumb)
• Imaging
  • 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 extening 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 fx if clinician is comfortable with the procedure

Disposition

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

See Also

• Hand and Finger Fractures

Source

UpToDate