Presentation
The patient presented to the emergency department with a week's history of right-hand swelling over the thumb and first metacarpal. The patient was boxing with friends and felt a sudden pain in their right hand after a punch.
Patient Data
An AP X-ray shows a two-piece fracture at the base of the first metacarpal with extension into the CMCJ. Noticeable soft tissue swelling of the first web space.
Case Discussion
The first metacarpal fracture or base of thumb fracture can be extra-articular or intra-articular (Bennett fracture and Rolando fracture). In this case, the fracture has extended into the carpometacarpal (CMC) joint with subluxation (i.e., instability), which would need surgical reduction and fixation. In cases of a stable, non-displaced fracture or displacement <1 mm, a thumb spica cast for 3-4 weeks can be considered.
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