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.

Fig. 1

(A and B) Radiographs of a case of Rolando fracture with displaced single and large palmar and dorsal fragments. (C and D) Radiographs of same case after open reduction and internal fixation with a miniature T-plate and screws, 1 and 12 weeks after surgery, respectively. A separate intrafragmentary lag screw with restoration of articular surface can also be seen. Although there is a small extra-articular step it was inconsequential.

Fig. 2

Image showing excellent functional results seen in the same patient at 6 weeks follow-up.