UMEM Educational Pearls

Title: First Metacarpal Fractures

Keywords: Bennett, Rolando, fracture (PubMed Search)

Posted: 6/30/2012 by Michael Bond, MD (Updated: 12/26/2024)
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First Metacarpal Fractures:

There are two types of fractures that commonly occur at the base of the 1st metacarpal. They are:

Bennett Fracture: This is an intraarticular fracture at the base of the 1st metacarpal that always involves some degree of subluxation or dislocation of the 1st carpometacarpal joint.

Bennett Fracture

Image from Wikipedia Commons

This is the most common fracture of the thumb.
This fracture is typically caused by axial loading the thumb while the metacarpal is partially flexed. A common mechanism is when a person punches a wall or hard object with their thumb take the brunt of the force.
Most of these fractures will require surgical repair but can be treated in the ED with a Thumb Spica Splint.

Rolando Fracture: This is a communited intraarticular fracture at the base of the first metacarpal that typically has a T or Y shaped configuration with 3 fragments.

Rolando Fx

Image courtesy of WikiPedia Commons

Less common then Bennett Fractures
Associated with a worse prognosis
Requires surgical repair but can be splinted in the ED with a thumb spica splint.