Thumb fracture: Difference between revisions
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==Background== | ==Background== | ||
{{Thumb fracture classification}} | |||
==Diagnosis== | ==Diagnosis== |
Revision as of 00:39, 18 May 2015
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
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
Differential Diagnosis
Hand and Finger Fracture Types
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
- Indicated for:
Disposition
- Refer within 3-5 days:
- All intraarticular fractures warrant referral (most require surgery)
- Extraarticular fractures that cannot be adequately reduced
See Also
Source
UpToDate