Rolando's Fracture
Rolando's Fracture is a comminuted intra-articular fracture of the base of the 1st Metacarpal (Thumb). It is essentially a more severe, 3-part (or more) version of Bennett's fracture.
1. Morphology
- Pattern: Typically Y-shaped or T-shaped fracture lines.
- Stability: Highly unstable and difficult to reconstruct surgically due to comminution.
- Prognosis: Worse than Bennett's fracture; high risk of arthritis.
2. Management
- Open Reduction (ORIF): Often impossible if fragments are too small. T-plates may be used for large fragments.
- External Fixation: Often the treatment of choice. Uses "ligamentotaxis" (distraction) to pull fragments into alignment without opening the site.
25 Practice MCQs
Q1. Rolando's fracture is best described as:
Answer: A). 3 or more fragments distinguish it from Bennett's.
Q2. The prognosis compared to Bennett's fracture is:
Answer: B). Comminution damages the cartilage significantly.
Q3. The classic fracture line shape is:
Answer: A). Splits the base into volar and dorsal fragments + shaft.
Q4. Is ORIF always feasible?
Answer: B). "Bag of bones" appearance makes plating hard.
Q5. External fixation relies on:
Answer: A). Distraction aligns the fragments using the soft tissue envelope.
Q6. Which bone is involved?
Answer: A). Base of thumb.
Q7. Is casting effective?
Answer: A). Highly unstable.
Q8. The mechanism of injury is usually:
Answer: A). Crushes the articular surface.
Q9. Rolando's fracture was described in:
Answer: A). By Silvio Rolando.
Q10. A specific plate used for Rolando's is:
Answer: A). Matches the T-shape fracture.
Q11. Bone grafting is used:
Answer: A). To elevate the joint surface.
Q12. Thumb spica splinting is used:
Answer: A). To protect the fixation.
Q13. Is it less common than Bennett's?
Answer: A). Bennett's is the most common thumb base fracture.
Q14. K-wire fixation (tension band) is an option for:
Answer: A). Need sufficient bone stock to hold wires.
Q15. Arthritis of the CMC joint causes pain with:
Answer: A). Axial loading and rotation (grind).
Q16. The volar oblique ligament attaches to the:
Answer: A). Usually one fragment stays stable while others explode.
Q17. Can arthroscopy be used?
Answer: A). "Nano-arthroscopy" is becoming more common.
Q18. Fusion (Arthrodesis) is indicated:
Answer: A). Provides a strong, painless, stable thumb (but no motion).
Q19. Range of motion exercises start:
Answer: A). Early motion prevents stiffness.
Q20. Complex Regional Pain Syndrome (CRPS) risk is:
Answer: A). Watch for disproportionate pain.
Q21. The CMC joint has how many degrees of freedom?
Answer: A). Saddle joint mechanics.
Q22. Malunion leads to:
Answer: A). Thumb web space narrows.
Q23. Dynamic traction involves:
Answer: A). Old technique, less used now but valid.
Q24. APL and Adductor Pollicis act as:
Answer: A). Pulling the shaft away.
Q25. What percentage of hand fractures involve the 1st MC base?
Answer: A). Common injury.
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