What is a Rolando fracture?

What is a Rolando Fracture?

A Rolando fracture is a comminuted, multifragmented, complete intra-articular fracture at the base of the first metacarpal (thumb) that involves the carpometacarpal (CMC) joint. 1, 2

Fracture Characteristics

• The fracture pattern is inherently unstable due to multiple fracture fragments breaking through the articular surface of the thumb metacarpal base 3, 2
• It represents a more severe injury than a Bennett fracture (which is a two-part intra-articular fracture), as Rolando fractures have three or more fragments creating a "T" or "Y" configuration 2
• The fracture typically results from high-energy axial loading mechanisms to the thumb 2

Clinical Significance

• Deforming forces acting at the base of the thumb cause these fractures to displace, making them challenging to manage 2
• The comminuted nature and articular involvement create risk for post-traumatic arthritis if not properly treated 2, 4
• Articular impaction is implicated as one of the causes of posttraumatic arthritis in severely comminuted cases 2

Treatment Principles

Displaced Rolando fractures require surgical treatment, as nonoperative management is rarely appropriate 1, 2

Key Treatment Goals:

• Achieve anatomical reduction of the articular surface to within 1 mm or less to reduce the risk of radiographic arthritis 2
• Restore joint congruity and stability at the trapeziometacarpal joint 3, 2

Common Surgical Approaches:

For fractures with larger fragments:

• Open reduction and internal fixation with plates or screws can be considered 2

For severely comminuted fractures (most common scenario):

• External fixation using ligamentotaxis is the preferred technique when fracture fragments are small and there is significant comminution 3, 2, 5, 4
• The external fixator spans the trapeziometacarpal joint, typically using pins in the trapezium and first metacarpal diaphysis 3, 5, 4
• Additional Kirschner wires may be added to maintain fracture reduction 5
• This approach provides excellent functional outcomes with mean QuickDASH scores of 7.95 and allows patients to return to previous activity levels 3

Important Clinical Caveat

Anatomic restoration of the articular surface is not essential to obtain a good functional result, though reduction should ideally be within 1 mm 2. This is reassuring given the technical difficulty of achieving perfect reduction in severely comminuted patterns, where external fixation relying on ligamentotaxis may be the most practical solution 3, 2, 5.