radER 3.2 Answer

rader new

Winners

David Mishkin

Marjan Siadat

Claire Jensen

Richard Gordon

Ayse Avcioglu

Case

A 23-year-old man presents to the ED complaining of left thumb pain after he collided with another player during a rugby match. There is swelling and tenderness at the base of the thumb.  You think the patient may have sustained a fracture of his proximal thumb so you order radiographs.  One of the radiographs is seen below:

thumb 2

Questions

1. What is the eponym for this fracture?

2. What is the ED management for this fracture?

3. Is the prognosis better or worse than the fracture seen in radER 3.1

Answers

1. Rolando Fracture – This is a  Y-shaped fracture of the base of the thumb metacarpal.  It can be considered an intraarticular, comminuted Bennett fracture.

thumb2a

2. ED Management requires a thumb spica splint and referral to a Hand specialist

3. The prognosis of a Rolando fracture is worse than a Bennett fracture, and operative fixation is usually necessary.

radER is a weekly contest consisting of a radiograph selected from various areas of emergency medicine that are central to the education of medical students and residents in training.

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