Fracture of Thumb

Fracture of Thumb
-Compensatory movement of the adjacent joints ->the thumb is more forgiving of
residual deformity than the fingers.
-Malrotation is rarely a problem.
-Angulation in frontal plane of less than 15 to 20 degrees are acceptable
-Angulation of less than 20 to 30 degrees in the lateral plane
-Articular fractures must be reduced anatomically to avoid loss of motion and
posttraumatic arthritis.
Thumb Phalangeal Fractures
Extraarticular Thumb Fractures
• Tuft fractures are usually comminuted and are nearly always associated with an
injury to the nail matrix or pulp,
• The fracture rarely requires reduction or fixation.
• Splint immobilization is used for 3 to 4 weeks.
Thumb Phalangeal Fractures
• Distal phalangeal transverse shaft fractures are potentiallyunstable.
The fracture angulates with its apex anterior secondary to the pull of the flexor
pollicis longus .
longitudinal Kirschner wire percutaneously across the fracture and into the head of
the proximal phalanx.
• Displaced spiral or oblique fractures may be treated by percutaneous
pinning or by open reduction with Kirschner wires or
interfragmentary screws.

• If open reduction of a fracture of the proximal phalanx is required,

the fracture is exposed through a dorsal “Y”-shaped incision with the
extensor pollicis longus insertion left intact
 Exposure of thumb metacarpal and phalanges. Interval between
extensor pollicis longus and extensor pollicis brevis is divided, with both tendons
left intact. When exposing thumb, care must be taken not to injure terminal
branches of superficial radial nerve or radial artery in anatomic snuffbox.
Articular Fractures and Avulsions of the Thumb
• Avulsion fractures of the dorsal base of the distal phalanx are
• designated a “mallet thumb.”
• treatment should consist of continuous extension splinting of the IP
joint for 6 weeks.
Avulsion fractures
• from the ulnar base of the proximal phalanx usually represent disruption of the
ulnar collateral ligament (gamekeeper’s or skier’s thumb).
• If the fragment is displaced more than 2 mm and the MP joint is unstable to
stress
Fractures of the Thumb Metacarpal
Metacarpal Head Fractures
- Displaced articular fractures require anatomic reduction
- Pin fixation, the thumb is immobilized for 2 to 3 weeks before
initiating motion.
- With screw fixation, motion is initiated at 5 to 7 days postoperatively.
Shaft Fractures of the Thumb
• They generally occur at the proximal metaphyseal-diaphyseal junction
and are referred to as epibasal.

The reduction is often unstable becauseof the

deforming force of the abductor pollicis.

In fractures angulated more than 30 degrees,

prefer closed reduction and percutaneous
pinning.
Articular Fractures of the Thumb Metacarpal Base:
Bennett Fracture
• Bennett fracture is really a fracture subluxation. The injury occurs when the
thumb metacarpal is axially loaded and partially flexed.
Rolando Fractures of the Thumb