Abstract
Introduction
Rolando type base of thumb metacarpal fractures are potentially debilitating injuries, which can be difficult to manage because of their inherent instability. Malunion is associated with stiffness, pain and weakness of pinch grip. We aimed to assess the outcome of a simple technique for the treatment of this fracture using the principle of ligamentotaxis, with a static, 2-pin external fixator spanning the trapeziometacarpal joint. We present the results and functional outcomes of this technique.
Methods
A consecutive series of 8 patients (7 males, 1 female) with Rolando type intra-articular fractures of the base of the first metacarpal was retrospectively reviewed. All cases were performed by the senior author using a static, 2-pin Mini-Hoffman external fixator. Case notes and radiographs were reviewed, and patients' functional outcome assessed using the Quick Disability of Arm, Shoulder and Hand (Quick DASH) scoring system. Mean age of the group was 32.8 years (range 18.1-52.3 years). Mean follow-up was 2.7 years (range 3.5 months to 6.0 years).
Results
The mean delay between injury and surgery was 6.6 days (range 1-11). The mean time to frame removal was 28 days (range 15-41). There were 3 cases of superficial pin site infection all of which were treated satisfactorily with oral antibiotic therapy. Follow-up radiographs did not demonstrate any significant joint incongruity or malunion in any case. The mean Quick DASH score was 8 (range 0-23). Mean scores for the work and sport components were 10 (range 0-25) and 3 (range 0-6) respectively.
Conclusion
The results of this study demonstrate that this simple method reliably gives excellent hand and thumb function with minimal impact upon work, sport or recreational activities. We recommend the use of spanning trapeziometacarpal external fixation for intra-articular fractures of the base of the first metacarpal.
