Treatment of Rolando Fractures by Open Reduction and Internal Fixation using Mini T-Plate and Screws

Abstract

Introduction?Rolando fractures being intra-articular fractures of the most mobile joint of the thumb, assume significance because any residual incongruity of the articular surface may result in loss of motion as well as secondary osteoarthritis and hence serious disability. This fracture continues to pose difficulties to the treating surgeons and although several treatment options have been described for these fractures, there are no definite guidelines. Methods?The present study describes the results of open reduction and internal fixation of nine Rolando fractures with large and single fragments, using mini T-plate and screws. Results?At 3-year follow-up all the fractures had united, functional results were excellent or good in most cases, and all the patients had returned to previous activities. Significant complications such as deep infection and loss of reduction were not encountered in any patient. Conclusion?Open reduction and internal fixation with mini T-plates in properly selected cases of Rolando fracture with large and single palmar and dorsal articular fragments offers several advantages such as allowing direct visualization of the joint, removal of interposed soft tissues, and exact anatomical restoration of the articular surface. The fixation in most cases is rigid enough to allow early mobilization without loss of reduction. Thus, complications such as stiffness as well as future arthrosis may be minimized. However, the technique is demanding and needs high degree of precision. The possibility of implant removal should be discussed beforehand with the patient.

Volar buttress plate fixation: An effective and reliable option for Bennett’s fractures

“…However, long-term soft tissue problems, particularly in dorsal plate applications, may arise. Mumtaz et al[ 18 ] found that four out of nine patients who were treated with a dorsal plate experienced local tenderness and pain, which resulted in the early removal of the plate and screws. The reduction of the volar part in Bennett's fractures may be difficult to identify and evaluate with the dorsal approach.…”

A Safe Method for Early Rehabilitation of Articular Fracture at the Base of Thumb Metacarpal Bone

“…Development of soft tissue problems, devascularization of fracture fragments, and collateral ligament and tendon injuries are more common in this method. In a study by Mumtaz et al [ 14 ], the implant was required to be removed in four of nine patients, who underwent open reduction and plate osteosynthesis, due to local tenderness and pain, and soft tissue problem and superficial infection were reported in two patients. Closed reduction and external fixator and pinning is presented as a much safer method for fractures of this region in terms of both joint restoration and early mobilization.…”

The Current Concept and Evidence-Based Practice in the Base of the First Metacarpal Bone Fracture

“…However, treating a Rolando fracture can be challenging due to the inherent nature of instability and comminuted patterns. There is also the risk of complications such as loss of reduction, joint incongruity, or the development of osteoarthritis [54,59].…”