Thumb Fracture

Thumb Fracture is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

  • 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

Etiology

  • Falls, hyperflexion, hyperextension
  • Motor vehicle accidents
  • Sports, especially downhill or alpine skiing
  • Basketball
  • Baseball
  • Football
  • Rugby

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Basics

Description

  • 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

Etiology

  • Falls, hyperflexion, hyperextension
  • Motor vehicle accidents
  • Sports, especially downhill or alpine skiing
  • Basketball
  • Baseball
  • Football
  • Rugby

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