Thumb fracture
Revision as of 15:27, 2 December 2014 by Rossdonaldson1 (talk | contribs) (Rossdonaldson1 moved page Thumb Fracture to Thumb fracture)
Background
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
- 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
- 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