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First Metacarpal Fractures:
There are two types of fractures that commonly occur at the base of the 1st metacarpal. They are:
Bennett Fracture: This is an intraarticular fracture at the base of the 1st metacarpal that always involves some degree of subluxation or dislocation of the 1st carpometacarpal joint.
Image from Wikipedia Commons
- This is the most common fracture of the thumb.
- This fracture is typically caused by axial loading the thumb while the metacarpal is partially flexed. A common mechanism is when a person punches a wall or hard object with their thumb take the brunt of the force.
- Most of these fractures will require surgical repair but can be treated in the ED with a Thumb Spica Splint.
Rolando Fracture: This is a communited intraarticular fracture at the base of the first metacarpal that typically has a T or Y shaped configuration with 3 fragments.
Image courtesy of WikiPedia Commons
- Less common then Bennett Fractures
- Associated with a worse prognosis
- Requires surgical repair but can be splinted in the ED with a thumb spica splint.