Thumb fracture: Difference between revisions
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{{Thumb fracture classification}} | {{Thumb fracture classification}} | ||
== | ==Clinical Features== | ||
*Important to distinguish tenderness at base of 1st MC from injury to scaphoid, trapezium, or distal radius | |||
*If pain or ecchymosis occurs more distally at the MCP (particularly on the ulnar side) consider ulnar collateral ligament injury ([[Gamekeeper's Thumb]]) | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Hand and finger fractures DDX}} | {{Hand and finger fractures DDX}} | ||
== | ==Evaluation== | ||
[[File:Bennetts Fracture.jpg|thumb|Bennett's fracture]] | |||
*Imaging plain films | |||
** | **AP, lateral, oblique | ||
* RICE | |||
** Significant swelling or overly aggressive icing to radial side of thumb may result in temporary palsy to the superficial radial nerve (numbness over the dorsum of the thumb) | ==Management== | ||
{{General Fracture Management}} | |||
*RICE | |||
**Significant swelling or overly aggressive icing to radial side of thumb may result in temporary palsy to the superficial radial nerve (numbness over the dorsum of the thumb) | |||
===Acute Reduction=== | |||
*Indicated for angulated (more than 20-30 degrees), extraarticular fracture if clinician is comfortable with the procedure<ref name="Hand and wrist emergencies">German C. Hand and wrist emergencies. In: Bond M, ed. Orthopedic Emergencies: Expert Management for the Emergency Physician. Cambridge: Cambridge University Press; October 31, 2013.</ref> | |||
===Immobilization=== | |||
*[[Splinting]] | |||
**Type I, II - [[Thumb Spica Splint]] with the IP joint free and wrist in 30 deg of extension | |||
**Type III - Short arm [[Thumb Spica Splint]] extending to the IP joint and wrist in 30 deg of extension | |||
==Disposition== | ==Disposition== | ||
* Refer within 3-5 days: | *Refer within 3-5 days: | ||
** All intraarticular fractures warrant referral (most require surgery) | **All intraarticular fractures warrant referral (most require surgery) | ||
** Extraarticular fractures that cannot be adequately reduced | **Extraarticular fractures that cannot be adequately reduced | ||
==See Also== | ==See Also== | ||
*[[Hand and finger fractures]] | *[[Hand and finger fractures]] | ||
== | ==References== | ||
<references/> | |||
[[Category: | [[Category:Orthopedics]] | ||
Latest revision as of 02:55, 18 September 2019
Background
Thumb fracture classification
- Type I (Bennett's fracture)
- Fracture-dislocation of the base of the metacarpal (intra-articular)
- Base fragment is aligned with trapezium, but distal portion is subluxed by abductor pollicis longus
- Most common type of thumb fracture; nearly always accompanied by some subluxation or dislocation of CMC
- Type II (Rolando's fracture)
- Comminuted version of a Bennett's fracture (intra-articular)
- Type III
- Extra-articular (transverse or oblique)
- Type IV
- Extra-articular pediatric fracture involving the proximal physis
Clinical Features
- Important to distinguish tenderness at base of 1st MC from injury to scaphoid, trapezium, or distal radius
- If pain or ecchymosis occurs more distally at the MCP (particularly on the ulnar side) consider ulnar collateral ligament injury (Gamekeeper's Thumb)
Differential Diagnosis
Hand and Finger Fracture Types
Evaluation
- Imaging plain films
- AP, lateral, oblique
Management
General Fracture Management
- Acute pain management
- Open fractures require immediate IV antibiotics and urgent surgical washout
- Neurovascular compromise from fracture requires emergent reduction and/or orthopedic intervention
- Consider risk for compartment syndrome
- RICE
- Significant swelling or overly aggressive icing to radial side of thumb may result in temporary palsy to the superficial radial nerve (numbness over the dorsum of the thumb)
Acute Reduction
- Indicated for angulated (more than 20-30 degrees), extraarticular fracture if clinician is comfortable with the procedure[1]
Immobilization
- Splinting
- Type I, II - Thumb Spica Splint with the IP joint free and wrist in 30 deg of extension
- Type III - Short arm Thumb Spica Splint extending to the IP joint and wrist in 30 deg of extension
Disposition
- Refer within 3-5 days:
- All intraarticular fractures warrant referral (most require surgery)
- Extraarticular fractures that cannot be adequately reduced
See Also
References
- ↑ German C. Hand and wrist emergencies. In: Bond M, ed. Orthopedic Emergencies: Expert Management for the Emergency Physician. Cambridge: Cambridge University Press; October 31, 2013.