Base of Thumb Fractures
- Base of thumb fractures can present similar very similar to scaphoid fractures and wrist/scaphoid fractures should be considered.
- Axial compression of the thumb will be very painful in base of thumb fractures.
- Request AP and Lateral and pronated oblique views of the thumb, focussing on the first metacarpal.
- Irrespective of the management plan, all base of thumb fractures can be immobilised in a thumb spica, which is a half cast immobilising the wrist and the thumb to the level of the interphalangeal joint. See splinting guideline.
Four types of fractures are commonly seen at the base of the first metacarpal:
- Extra-articular transverse or oblique.
- Oblique intra-articular fracture: Bennett’s fracture.
- Y shape intra-articular fracture: Rolando’s fracture.
- All these fractures can be immobilised initially with a thumb spica cast.
- The extra-articular fractures with minimal alignment deformity will be considered for conservative treatment. Conservative treatment implies only casting or thermoplastic splinting by hand therapist for 4 to 6 weeks.
- Rolando & Bennett type fractures will usually be treated surgically. These fractures are unstable and are commonly seen as fracture dislocations. After open or closed reduction, percutaneous wires or internal fixation are used to fix the fractures. It will then be immobilised for 4-6 weeks.
Rehabilitation by hand therapist post surgery
- Protect the fracture fixation with a forearm based thumb spica with the first webspace maintained and the wrist in 20 degrees extension, thumb in abduction, MCPJ flexed to 20 degrees and the IPJ left free. The splint should be worn full time for 4-6 weeks.
- Monitor the wound or pin sites, change dressings and remove sutures if required.
- Oedema management through elevation, compression wrap and anti-oedema exercises.
- Once the wound has healed, scar management, consisting of scar massage, issuing of silicon products and pressure garments is carried out.
- Prevent stiffness of the unaffected joints through the provision of a home exercise programme.
- Commence graded range of movement exercises of the thumb and wrist after 4-6 weeks of immobilization, once the fracture is stable. Progress to passive exercises at 6-8 weeks, depending on clinical signs of healing.
- Commence thumb and hand strengthening at 8 weeks post injury, depending on clinical signs of healing.