The hand consists of five bones called metacarpal bones for all the five digits. The knuckles at the back of the hand are formed by the end of the metacarpal bones, which also assist or support the hand. Metacarpal fracture occurs when one of the long bones gets injured. This could happen by performing certain activities like punch or direct impact to the hand due to which stress is placed on the metacarpal bones. As this kind of stress could be traumatic and beyond what the bone can withstand, an injury or a break in one or more metacarpals occurs. Thus the condition is called as metacarpal fracture. In other words, metacarpal fracture can be termed as broken hand.
Rolando Fracture is a condition in which the base of the first metacarpal bone gets fractured where it articulates with the trapezium. Trapezium is one of the eight carpal bones in the wrist that forms a joint at the base of the thumb known as first carpometacarpal joint. The joint of the trapezium and thumb metacarpal base form a saddle like structure that aids significantly in the joint's stability. This joint is covered by smooth cartilage at the ends of the metacarpal and trapezium, which allows easy articulation of the bones during motion.
Although a Rolando fracture is very similar to Bennett fracture, the Rolando fracture is recognized by its nature of fracturing the metacarpal base into two, three and sometimes many fragments. The appearance of the Rolando fracture could be in the shapes of Y or T because of which the Rolando fracture is also called as Y or T shape fracture.
Rolando fracture can be a result of injuries suffered during most of the contact sports such as boxing, rugby and soccer.
Causes of Rolando Fracture
Rolando fractures are mostly caused as a result of indirect forces such as falling on a thumb that is projecting out or a blow on a clenched fist. Punching is the most common mechanism which leads to this type of fracture, however, there are many other reasons such as motor vehicle accidents, work-related injuries and falls.
Rolando fracture is a severe type of fracture, which if treated inappropriately can lead to permanent disability in terms of activities, which involve use of the thumb such as pinching.
Signs and Symptoms of Rolando Fracture
- Sudden pain and swelling in the wrist and thumb.
- Tenderness with palpation.
- Pain with movements of hand.
- Thumb joint instability impairing normal movement of thumb.
- Deformity of thumb.
Treatment for Rolando Fracture
- Rolando fracture is difficult to treat, and surgery is almost always required to treat the fracture as it is very important that the shape of the joint surface is maintained and all the fractured fragments are well aligned.
- Surgery involves realigning the bone fragments and fixing them with metal implants such as plates, wires, and screws that are used to fix the broken fragments of bone depending upon the nature and type of the fracture.
- This is followed by a period of immobilization with a thumb spica cast or splint, which is a specially designed cast or splint.
- Surgery has its risks of bleeding, neurovascular injury, etc.
Exercises for Rolando Fracture
Stretching and strengthening exercises may need to be performed during the recuperation period for complete motion of the digit.
Stretching Exercises for Rolando Fracture
- Flexion: This form of exercise is done by bending wrist forward until there is a painless stretch sensed and to hold this for 6 seconds. Try and do this in two sets, 15 times each.
- Extension: This form of exercise is done by bending wrist backward until there is painless stretch sensed and to hold this for 6 seconds. Try and do this in two sets, 15 times each.
- Side to Side: This form of exercise is done by moving wrist sideways until there is painless stretch sensed and to hold this for 6 seconds in one individual direction. Try and do this in two sets, 15 times each.
Strengthening Exercises for Rolando Fracture
- Opposition Stretch: This is done by placing hand on an object with palms looking upwards. The, try and join tip of thumb with tip of small finger and do it for about 5 seconds and do it 10 times.
- Wrist Flexion: This is done by holding a handle with palms in upward direction. Then the wrist is bent upwards. Slowly, the weight is decreased. Try and do this in two sets, 15 times each and try to increase the weight.
- Wrist Extension: This is done by holding a handle with palms in downward direction. Then the wrist is bent upwards. Slowly, the weight is decreased. Try and do this in two sets, 15 times each and try to increase the weight.
- Grip Strengthening: To do this type of exercise, take a spongy object and try to squeeze it hard for about 5 seconds. Try and repeat it 10 times without exacerbating symptoms.
- Finger Spring: This is done by wearing a band on the outer side of the fingers to include the thumb. Now, try and stretch the band by stretching the fingers. Try and do this in three sets of 10.
Investigations for Rolando Fracture
A physical examination is conducted for diagnosis of Rolando fracture. A neurovascular examination is also done to rule out any injury to the nerves or vessels. An x-ray is also done to find out about the severity of fracture, if present.
Other Diagnostic Studies Include
- CT scan