EM REMS

I posted a radiograph earlier asking about Bennett’s and Rolando fractures.  This is the patient’s CT obtained later to further characterize the fracture:

This is a Bennett’s fracture pattern.  Bennett’s is a fracture of the base of the 1st Metacarpal that involves the articulation and usually has some dislocation of the CMC (carpal-metacarpal) joint.  This fracture does have slight dislocation at the 1st CMC joint.

The Rolando’s fracture pattern is more comminuted, usually T or Y shaped comminution.  It carries a worse prognosis although the Bennett’s also has high incidence of arthritis even with optimal management.

Author:  Russell Jones, MD

This is a patient with pain in the thumb after punching another person:

Fractures of the base of the 1st (thumb) metacarpal are highly morbid injuries.  Most of these should be operative but many end up with severe arthritis of the MCP joint despite optimal therapy.  The thumb is a very important functional joint especially on the dominant hand, as in this patient.

Radiographically there are several eponym fractures for the base of the 1st metacarpal:  Rolando and Bennett are the most widely discussed eponym fractures.

Which one is this (if either)?

Answer to follow.

Author:  Russell Jones, MD