Thumb Fracture

Basics

Distal phalangeal fractures:
- Blunt trauma, hyperextension of the thumb, axial loading of the thumb, and crush injuries
- Tuft fracture is a similar fracture in other digits, in which the distal phalanx is crushed and/or fragmented
- It may be open or closed and associated with nail bed injury
- Severe nail bed injury, intra-articular, displaced/angulated fractures, or tendon injuries warrant orthopedics’ consultation
- Noncomplex tuft fractures can be splinted and treated as soft tissue injuries
- Larger subungal hematomas should be decompressed or drained
Thumb proximal phalangeal fractures:
- Blunt trauma to the thumb:
  - Axial loading of the thumb with the metacarpophalangeal (MP) joint partially flexed, the hand closed or the thumb MP joint otherwise stabilized
Thumb metacarpal fractures:
- Bennett fracture (type I):
  - Intra-articular fracture/dislocation at the base of the metacarpal where the ulnar aspect of the metacarpal maintains its attachment
- Rolando fracture (type II):
  - Comminuted Y- or T-shaped intra-articular fracture of the base of the first metacarpal
  - Similar to a comminuted Bennett, these can be much more complex with multiple comminuted fractures. Usually greater force
- Type III fractures:
  - Extra-articular metacarpal fractures. Tend to be transverse(IIIa) or less commonly oblique(IIIb)
  - Type IV: Epiphyseal injuries seen in children

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