Rolando Fracture

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There are five fingers (also known as digits) attached to the human hand. The four fingers can be folded over the palm which allows the grasping of items. Each finger, beginning with the nearest to the thumb, has a name to distinguish it from the rest, which are as follows: the index finger, the middle finger, the ring finger, and the little finger. The thumb is the first of the hand’s five digits, but it is typically not referred to as a ‘finger’. The thumb possesses a unique and wide range of motion not shared by the hand’s other digits. Not only does it bend its knuckle, but the tip of the thumb can touch the tips of the fingers.

A Rolando fracture is a type of bone fracture that occurs at the base of the thumb, which was first described by an individual by the name of Silvio Rolando in the 20th century. It is a serious injury of the thumb that can be incredibly unstable, making treatments difficult to resolve. Generally, the thumb is the most important digit of the hand. Because the thumb opposes the other four fingers, it is critical in grip strength. Without the thumb, people might have trouble picking up objects and holding items. An injury to the thumb can seriously hamper someone’s quality of life.

In a Rolando fracture, the hand sustains a direct blow while the thumb is flexed, such as in the shape of a fist. This comes in contrast to a hand being extended while someone falls, as is common in other injuries. If the thumb is curled inward in the shape of a fist while an impact occurs, it might lead to a Rolando fracture.

There are many ways this injury might occur…first, if someone is involved in an auto accident, their thumb and fingers might be wrapped around the steering wheel at the time of impact; this can expose their thumb to this injury. Similar situations might be encountered in a bicycle accident or motorcycle accident. Other common mechanisms include a slip and fall accident, or a crush injury involving a direct impact to the base of the thumb. If anyone sustains an injury to their hand in a traumatic accident, it is highly recommended to undergo a diagnosis.

Causes & Symptoms

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The base of the thumb can be fractured during falls, sports injuries, and many other forms of hard impact or abnormal twisting motions. Rolando fractures are a serious, but temporary problem that can affect the ability to grasp objects. Any of the bones of the thumb can be fractured, however, thumb fractures most commonly occur at the base of the metacarpal bone. In children, Rolando fractures may involve the physis (growth plate) if they are close to the base of the metacarpal bone.

In addition to Rolando fractures, there is another type of thumb fracture known as a Bennet fracture. A Bennett’s fracture is an intra-articular fracture of the base of the first metacarpal, with resultant dislocation of the first carpometacarpal joint. The fracture is unstable and inadequate treatment leads to osteoarthritis, weakness, and loss of function of the first metacarpal joint. Both the Rolando and Bennet fracture are the most common fracture to affect the thumb and are serious injuries.

Some common causes of Rolando fractures include the following:

  • Painful to touch or move – The pain will constantly worsen when you attempt to move your thumb, especially if you try to form a grip an object.
  • Difficult to move – A loss of motion and ability in the thumb is common. It is less common for someone to experience a complete loss of motion in a fractured thumb, and this is typically an indication of a more severe fracture. A Rolando fracture will generally remain unstable, albeit through intense acute pain.
  • A tingling sensation, or numbness – This occurs as a result of the restricted blood flow to the thumb.
  • Feeling of being pierced through – It may be apparent that your thumb is deformed as a result of a moderate to severe fracture. With more severe Rolando fractures, you may experience the end of the bone piercing the skin. This is also known as an open fracture.
  • Sudden swelling – Visible bruising around the base of the thumb will appear rapidly, almost instantly. This occurs because when a fracture of any sort occurs, the fractured fragments will bleed into the tissue; hence what forms the bump and bruising.

In severe cases, if you believe you have broken your thumb, it is essential you seek immediate medical attention. As with any kind of finger fracture, putting off a professional diagnosis just prolongs the risk of a poor recovery. Here are some risks of a delayed diagnosis regarding a Rolando fracture:

  • Disability – In most severe cases, you may completely lose the ability to use the afflicted thumb.
  • Loss of motion – You may not retain the same ease of use in your fractured thumb.
  • Insufficient healing – This can lead to weaker bone structure and disfigurement.

Who gets Rolando Fracture?

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The most common causes of a Rolando fracture may include a fall, an attempt to catch a ball, or in most severe cases, going through a motorcycle accident. Your first metacarpal bone can also fracture from twisting or muscle contraction. Sports where a Rolando fracture is more likely to occur include:

  • Wrestling
  • Basketball
  • Baseball
  • Skiing
  • Hockey

How Does it Affect You? How Serious is it?

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Rolando fractures can become well-associated with longer-term consequences if left untreated. One of the most common complications that are accompanied by an untreated Rolando fracture is osteoarthritis. Osteoarthritis is a common type of joint disease – it usually affects the weight-bearing joints, such as the cervical spine, lumbosacral spine, hips, knees, feet.

Other joints that are also commonly affected are the joints located within the fingers, such as the thumb. The main causes associated with osteoarthritis include pain, stiffness, and loss of ability to move from the affected area. The pain in osteoarthritis is often worsened by a long duration of activity and relieved whenever your leave the affected thumb to rest.

Recommended Treatment & Rehabilitation

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If you choose to undergo a diagnosis due to a Rolando fracture, your doctor will likely begin by performing a detailed physical exam. He or she will start to test the strength and range of motion of your hand and fingers. Because this fracture is unstable, there will be evidence of significant weakness in the thumb. This will prompt your doctor to order further medical imaging equipment.

Typically, an X-ray alone is enough to help diagnose this injury. The X-ray will be taken from multiple angles. In this injury, the thumb is typically broken in multiple spots, creating a T or a Y shape in the thumb itself. When the thumb breaks into multiple pieces, the muscles surrounding the thumb are able to pull on the bone fragments without any opposition from the other side. As a result, the muscles are able to pull the bone fragments out of position. This may be the reason why the injury is unstable. Therefore, your doctor may also order other imaging modalities (such as an MRI), in order to look for other associated injuries.

Because the muscles in the hand and thumb have pulled the bone fragments out of position, a Rolando fracture might require surgical reduction and internal fixation. When your surgeon opens up the hand to perform the repair, he or she will try to restore the joint surface as much as possible. This will help you avoid long-term symptoms and prevent the development of early-onset arthritis. Your surgeon will use screws, plates, and wires to place the bone fragments back in the proper position. He or she will also inspect the ligaments in the hand itself and ensure that these aren’t torn.

After surgery has been done, the joint is then immobilized for 4 to 6 weeks in a thumb spica cast, where the thumb is kept separate from the hand. In general, a Rolando fracture has a poorer prognosis for people to make a full recovery after this injury. Therefore, it may take some time for you to recover, however, with the help of physiotherapy, you can restore the strength in your thumb.

Many patients require physiotherapy for range-of-motion exercises. Stiffness and swelling are of great concern and may be long-term reminders of the injury. Here are some examples of typical rehabilitation for Rolando fractures:

 

Thumb IP flexion

Place your forearm and hand on a table with your affected thumb pointing up. With your other hand, hold your thumb steady just below the joint nearest your thumbnail. Bend the tip of your thumb downward, then straighten it. Repeat this method 8-12 times.

Thumb MP flexion

Place your forearm and hand on a table with your affected thumb pointing up. With your other hand, hold the base of your thumb and palm steady. Bend your thumb downward where it meets your palm, then straighten it. Repeat this stretch 8-12 times.

Thumb opposition

With your affected hand, point your fingers and thumb straight up. Your wrist should be relaxed, following the line of your fingers and thumb. Touch your affected thumb to each finger, one finger at a time. This will look like an “okay” sign, but try to keep your other fingers straight and pointing upward as much as you can. Repeat this method 8-12 times a day.

Thumb extension

First, place your hand flat on a table, palm down. Then, lift and lower your affected thumb off the table. Repeat this exercise 8-12 times a day.

Towel squeeze

Place a small towel roll on a table. With your palm facing down, grab the towel and squeeze it for about 6 seconds. Finally, slowly straighten your fingers to release the towel. Repeat this exercise 8-10 times a day.

Towel grab

Begin by folding a small towel in half and laying it flat on a table. Next, put your hand flat on the towel, palm down. Grab the towel and scrunch it towards you until your hand is in a fist. Slowly straighten your fingers to push the towel back so it is flat on the table. Repeat this exercise 8-12 times a day.

Alternative & Homeopathic Treatment

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Once a cast or splint has been applied to your Rolando fracture, you will likely still feel pain for at least a few days. Usually, over-the-counter (OTC) pain relievers are enough to cure pain, including non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen. Here are other homeopathic treatments to help reduce a Rolando fracture:

 

  • Elevation – Keep your hand elevated above the level of your heart as much as possible. Elevation helps reduce swelling, therefore, the more your finger is swollen, the more time it will take to heal once it is elevated.

 

  • Ice application – If you have a splint that allows you to feel the ice, consider applying an ice pack to your fingers a few times a day for 20 minutes at a time for the first few days after the fracture. This will help reduce further swelling.