Treatment of Rolando Fractures by Open Reduction and Internal Fixation using Mini T-Plate and Screws

Abstract

Introduction Rolando fractures being intra-articular fractures of the most mobile joint of the thumb, assume significance because any residual incongruity of the articular surface may result in loss of motion as well as secondary osteoarthritis and hence serious disability. This fracture continues to pose difficulties to the treating surgeons and although several treatment options have been described for these fractures, there are no definite guidelines.

Methods The present study describes the results of open reduction and internal fixation of nine Rolando fractures with large and single fragments, using mini T-plate and screws.

Results At 3-year follow-up all the fractures had united, functional results were excellent or good in most cases, and all the patients had returned to previous activities. Significant complications such as deep infection and loss of reduction were not encountered in any patient.

Conclusion Open reduction and internal fixation with mini T-plates in properly selected cases of Rolando fracture with large and single palmar and dorsal articular fragments offers several advantages such as allowing direct visualization of the joint, removal of interposed soft tissues, and exact anatomical restoration of the articular surface. The fixation in most cases is rigid enough to allow early mobilization without loss of reduction. Thus, complications such as stiffness as well as future arthrosis may be minimized. However, the technique is demanding and needs high degree of precision. The possibility of implant removal should be discussed beforehand with the patient.

Keywords

Rolando fracture - base of first metacarpal fracture - internal fixation - mini Tplate

• References

• 1 Foster RJ, Hastings II H. Treatment of Bennett, Rolando, and vertical intraarticular trapezial fractures. Clin Orthop Relat Res 1987; 214 (214) 121-129
• 2 Liverneaux PA, Ichihara S, Hendriks S, Facca S, Bodin F. Fractures and dislocation of the base of the thumb metacarpal. J Hand Surg Eur Vol 2015; 40 (1) 42-50
• 3 Rolando S. Fracture de la base du premier metacarpien, et principalement sur une variete non encore decrite. Presse Med 1910; 18: 303
• 4 Proubasta I, Lamas C, Itarte J, Sarasquete J, Carrera I. Rolando fractures. Curr Orthop Pract 2010; 21 (6) 615-623
• 5 Breen TF, Gelberman RH, Jupiter JB. Intra-articular fractures of the basilar joint of the thumb. Hand Clin 1988; 4 (3) 491-501
• 6 Green DP, Butler TE. Rockwood and Green's Fractures in Adult's. 4th ed. Philadelphia, PA: Lippincott-Raven; 1996
• 7 Houshian S, Jing SS. Treatment of Rolando fracture by capsuloligamentotaxis using mini external fixator: a report of 16 cases. Hand Surg 2013; 18 (1) 73-78
• 8 Gedda KO, Moberg E. Open reduction and osteosynthesis of the so-called Bennett's fracture in the carpo-metacarpal joint of the thumb. Acta Orthop Scand 1952; 22 (1–4) 249-257
• 9 Gelberman RH, Vance RM, Zakaib GS. Fractures at the base of the thumb: treatment with oblique traction. J Bone Joint Surg Am 1979; 61 (2) 260-262
• 10 Rüedi TP, Burri C, Pfeiffer KM. Stable internal fixation of fractures of the hand. J Trauma 1971; 11 (5) 381-389
• 11 Buchler U, McCollam SM, Oppikofer C. Communited fractures of the basilar joint of the thumb: combined treatment by external fixation, limited internal fixation and bone grafting. J Hand Surg [Br] 1991; 16A: 556-560
• 12 Zemirline A, Lebailly F, Taleb C, Facca S, Liverneaux P. Arthroscopic assisted percutaneous screw fixation of Bennett's fracture. Hand Surg 2014; 19 (2) 281-286
• 13 Gingrass RP, Fehring B, Matloub H. Intraosseous wiring of complex hand fractures. Plast Reconstr Surg 1980; 66 (3) 383-394
• 14 van Niekerk JLM, Ouwens R. Fractures of the base of the first metacarpal bone: results of surgical treatment. Injury 1989; 20 (6) 359-362
• 15 Greeven AP, Alta TD, Scholtens RE, de Heer P, van der Linden FM. Closed reduction intermetacarpal Kirschner wire fixation in the treatment of unstable fractures of the base of the first metacarpal. Injury 2012; 43 (2) 246-251
• 16 Mahoney M, Marsland D, Garagnani L, Sauve P '. Rolando and his fracture. Trauma 2015; 17 (1) 24-28
• 17 Cooney III WP, Chao EYS. Biomechanical analysis of static forces in the thumb during hand function. J Bone Joint Surg Am 1977; 59 (1) 27-36
• 18 Fyfe IS, Mason S. The mechanical stability of internal fixation of fractured phalanges. Hand 1979; 11 (1) 50-54
• 19 Black D, Mann RJ, Constine R, Daniels AU. Comparison of internal fixation techniques in metacarpal fractures. J Hand Surg Am 1985; 10 (4) 466-472
• 20 Black DM, Mann RJ, Constine RM, Daniels AU. The stability of internal fixation in the proximal phalanx. J Hand Surg Am 1986; 11 (5) 672-677
• 21 Langhoff O, Andersen K, Kjaer-Petersen K. Rolando's fracture. J Hand Surg [Br] 1991; 16 (4) 454-459