What is it?
Bennett fracture: a partial intraarticular fracture of the base of the 1st metacarpal
Rolando fracture: a Y or T shaped complete intraarticular fracture of the base of the 1st metacarpal
Why do we care?
Could you imagine going through life without working thumbs?
80% of thumb fractures involve the metacarpal base.
Bennett and Rolando fractures are associated with a high risk of early arthritis and mechanical limitations, especially if reduced inappropriately.
When to suspect it?
Usually caused by axial force applied to the flexed thumb.
Patients will experience pain at the base of the thumb, with possible swelling, ecchymosis and tenderness to the area, and worsened pain with range of motion.
For all suspected thumb fractures, get dedicated thumb Xrays, but if you see normal Xrays and still have a high clinical suspicion for injury, get a true AP view of the thumb (AKA Roberts view).
How do we manage it?
Nonoperative: Closed reduction with thumb spica splint for Bennett fractures with <1mm displacement or suspected fractures without obvious radiographic evidence.
Reduce with axial traction, opposition of the thumb metacarpal joint, and radial pressure over the metacarpal base.
Refer to hand surgeon.
Operative: Bennett fractures with >1mm displacement and basically all Rolando fractures (while patient is in ED, have a discussion with a hand surgeon)
Sources
https://www.orthobullets.com/hand/6036/base-of-thumb-fractures
https://www.ebmedicine.net/media_library/files/1214%20Hand%20Injuries(1).pdf