Trapeziometacarpal External Fixation under Local Anesthesia for the Treatment of Comminuted Intra-Articular Thumb Metacarpal Fractures: Evaluation of Clinical Results and Long-Term Patient Satisfaction

Abstract

Background A variety of internal and external fixation techniques have been described for the treatment of Rolando fractures, but the optimal fixation method has not been clearly defined. Purpose The aim of the study was to describe the results and the long-term functional outcome of the application, under local anesthesia, of an external fixation system for the treatment of Rolando fractures. Patients and Methods In total, 22 consecutive patients (16 men) underwent surgical treatment for Rolando fractures by using two pairs of pins external fixator. All procedures were performed under local anesthesia (Xylocaine 2%) and an image intensifier. Patients were evaluated at regular intervals postoperatively and contacted by phone for long-term follow-up. Functional outcome was assessed using the validated Quick Disabilities of the Arm, Shoulder, and Hand (Quick DASH) tool. Results The mean age was 39.8 ± 14.2 years. The mean time from injury to surgery was 4.1 ± 2 days. The mean operative time was 16.3 ± 2.6 minutes. All fractures were healed and no loss of fracture reduction was observed postoperatively. One patient developed wound erythema at the proximal pins, without requiring early removal of the implant, and another one experienced temporary numbness at the distribution of the superficial radial nerve. In total, 20 out of the 22 patients who were available for long-term follow-up did not report any complaints and could perform the daily activities without restriction. The average follow-up was 6.5 ± 1.2 years, and the mean Quick DASH score was 1.8 ± 3. Conclusion The two pairs of pins external fixator is a valuable option for the treatment of Rolando fractures and can be easily, quickly, and effectively applied under local anesthesia.

Keywords: Rolando fracture; external fixation; metacarpal fractures; thumb; trapeziometacarpal joint.

Fig. 1

( A ) Intraoperative photo illustrates the setup of the operating room and the position of the operated hand over the image intensifier C-Arm. ( B ) Intraoperative and ( C ) postoperative (6 weeks) photographs show the position and location of external fixation.

Fig. 2

( A ) Anteroposterior X-ray of the right hand shows a Rolando fracture of the base of first metacarpal. ( B ) Intraoperative fluoroscopic view of fracture reduction and fixation with a two-pair pins external fixator. ( C ) Anteroposterior hand X-ray at 6 weeks postoperatively shows healing of the fracture. ( D ) Anteroposterior hand radiograph at 1 year postoperatively shows complete fracture union and no displacement or arthritis.