Treatment for Thumb Fractures
The treatment for thumb fractures depends on the fracture type, location, and displacement, with stable non-displaced fractures typically managed with casting or splinting, while displaced or unstable fractures often require surgical fixation. 1
Initial Assessment and Imaging
- Initial evaluation should include 3-view radiographs of the hand (posteroanterior, lateral, and oblique) to confirm the diagnosis and assess fracture characteristics 2
- For thumb fractures specifically, a 2-view radiographic examination is usually sufficient, though adding an oblique projection increases diagnostic yield 2
- When initial radiographs are equivocal but clinical suspicion remains high, CT without IV contrast can provide better visualization of fracture patterns 2
- Three-dimensional CT reconstructions are particularly helpful for preoperative planning of complex articular injuries 2
Treatment Based on Fracture Type
Extra-articular Thumb Fractures
- Stable, non-displaced extra-articular fractures can be effectively treated with closed reduction and casting 1
- For minimally displaced fractures, removable splints are an appropriate treatment option 3
- Active finger motion exercises should be performed during immobilization to prevent stiffness 2
Intra-articular Thumb Fractures
- Displaced intra-articular fractures (Bennett, Rolando, or comminuted patterns) generally require surgical intervention 1, 4
- Bennett fractures typically require closed reduction with percutaneous pinning or open reduction with internal fixation 1, 4
- Rolando and comminuted fractures often need more advanced fixation techniques such as locking plates or external fixation 1
- Surgical fixation is suggested for fractures with post-reduction radial shortening >3 mm, dorsal tilt >10°, or intra-articular displacement 2
Trapezium Fractures
- Fractures of the trapezium are rare but when displaced, operative treatment is recommended to prevent osteoarthritis of the first carpometacarpal joint 4
Immobilization Techniques
- For non-displaced or minimally displaced thumb fractures, immobilization in a short arm cast or splint is typically sufficient 3
- The duration of immobilization depends on fracture location and severity, but radiographic follow-up is recommended at approximately 3 weeks and at the time of immobilization removal 3
- Evidence suggests that immobilizing the thumb may not always be necessary for certain fracture types, as demonstrated in studies of scaphoid fractures where thumb immobilization did not improve union rates 5, 6
Rehabilitation Considerations
- Patients should perform active finger motion exercises following diagnosis to prevent stiffness 2
- A home exercise program is an appropriate option for patients after thumb fracture treatment 2
- Patients do not need to begin early wrist motion routinely following stable fracture fixation 2
- Vitamin C supplementation is suggested for the prevention of disproportionate pain during recovery 2
Special Considerations for Elderly Patients
- In patients over 55 years with distal radius fractures, evidence does not demonstrate clear differences between casting and surgical fixation 2
- For elderly patients with fragility fractures, a balanced approach regarding operative versus non-operative treatment is required 2
- Most proximal humeral fractures in elderly patients can be treated non-operatively with good functional outcomes 2
Potential Complications
- Monitor for complications such as skin irritation, muscle atrophy, joint stiffness, and complex regional pain syndrome during immobilization 3
- Achieving anatomical reduction is paramount to prevent complications such as joint incongruity, instability, and post-traumatic arthritis 1
- Hand stiffness is one of the most functionally disabling adverse effects following fractures of the hand and should be prevented through early motion exercises 2