Rolando fracture

Last revised by Leonardo Lustosa on 14 Sep 2022

Rolando fracture is a three-part or comminuted intra-articular fracture-dislocation of the base of the thumb (proximal first metacarpal). It can be thought of as a comminuted Bennett fracture.

The vast majority of cases occur in men, with a male to female predominance of 10:1. It is most common in the 20 to 40 years age range 3.

The mechanism is usually an axial blow to a partially flexed metacarpal, such as a fistfight. The fracture line is typically T- or Y-shaped. The volar fragment remains attached to the carpometacarpal joint, while the main dorsal fragment subluxes/dislocates dorsally and radially due to the unopposed pull of the abductor pollicis longus muscle.

This is an unstable injury that requires surgical reduction and fixation.

It is named after Silvio Rolando (Italian surgeon) who first described the fracture in a small case series of thumb metacarpal fractures in 1910. In his article, three of the twelve patients had a Rolando fracture 3.

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Cases and figures

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