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11-13: Bennett and Rolando Fractures

Meghan Breed; Robert Warne Fitch

Clinical Summary

A Bennett fracture is an intra-articular fracture at the ulnar aspect of the base of the 1st metacarpal, with radial displacement of the thumb metacarpal and subluxation or dislocation of the carpometacarpal joint. Patients complain of pain, swelling, and decreased range of motion. A Rolando fracture is an intra-articular comminuted fracture at the base of the 1st metacarpal, with radial and ulnar fragments resulting in a Y- or T-shaped intra-articular fragment.

FIGURE 11.40

Intra-articular Fractures of the First Metacarpal Base. Normal anatomy (A). A radial, intra-articular fracture at the base of the first metacarpal is a Bennett fracture (B). A comminuted intra-articular fracture at the base of the first metacarpal is a Rolando fracture (C).

Three illustrations depict Intra-articular Fractures of the First Metacarpal Base.
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Management and Disposition

Treatment consists of ice, elevation, immobilization in a thumb spica splint, and early referral to a hand specialist. These fractures generally require operative reduction and fixation.

FIGURE 11.41

Bennett Fracture. Bennett fracture involves the base of the first metacarpal. The digit is swollen and ecchymotic over the affected area. (Photo contributor: Daniel L. Savitt, MD.)

In a patient with a Bennett Fracture involving the base of the first metacarpal, the area around the base of the thumb is swollen and slightly bruised.
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FIGURE 11.42

Bennett Fracture. Radiographic examination of a Bennett fracture illustrates an intra-articular fracture at the base of the first metacarpal with the metacarpal displaced radially and proximally. (Photo contributor: Cathleen M. Vossler, MD.)

An x-ray of the hand reveals a Bennett Fracture at the base of the first metacarpal or the thumb. It is displaced inward.
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Pearls

  1. Osteoarthritis is a common long-term complication, even after optimal management.

  2. Swelling can mask significant angulation.

  3. Neurovascular and tendon injuries are not commonly associated with Bennett and Rolando fractures.

FIGURE 11.43

Rolando Fracture. Note the comminuted intra-articular fracture at the base of the first metacarpal. (Photo contributor: Cathleen M. Vossler, MD.)

An x-ray of the hand reveals a Rolando Fracture. There is a fracture at the base of the thumb with a corner chipped off.
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