Question 1

What's the difference between a Bennett fracture and a Rolando fracture, and does it matter for treatment?

Accepted Answer

Both are fractures at base of thumb metacarpal involving the carpometacarpal (CMC) joint, but differ in fracture pattern and severity. BENNETT FRACTURE (80% of thumb base fractures): SIMPLE two-part fracture - diagonal/oblique fracture line separates small triangular fragment (stays attached to trapezium bone by volar oblique ligament) from main metacarpal shaft - main shaft pulled out of position by abductor pollicis longus muscle creating subluxation - INTRAARTICULAR (fracture enters joint surface). ROLANDO FRACTURE (15%): COMMINUTED three or more-part fracture - classically T-shaped or Y-shaped pattern splitting thumb base into multiple fragments - much more difficult to reduce and fix - also intraarticular. EXTRAARTICULAR THUMB BASE FRACTURES (5%): Fracture at thumb metacarpal base NOT involving joint - typically stable, heal well with casting alone. WHY IT MATTERS: (1) STABILITY: Bennett inherently unstable (muscle pull), almost always requires surgery (pinning or screws) - extraarticular fractures usually stable, can cast alone | (2) TREATMENT: Bennett can often be fixed with closed reduction and pinning (pins through skin, no incision) - Rolando usually requires open surgery (incision to directly reduce multiple fragments) or may be too comminuted to fix perfectly | (3) PROGNOSIS: Bennett fractures treated well have excellent outcomes (85-90% return to normal function, low arthritis risk) - Rolando fractures have worse prognosis even with optimal treatment (30-50% develop arthritis because comminution damages cartilage) | (4) RECOVERY: Bennett with pinning: back to normal 3-4 months - Rolando with open fixation: 4-6 months, some permanent thumb stiffness/weakness common. MECHANISM: Bennett usually lower-energy (fall on thumb, punch) - Rolando higher-energy (severe crush, high-speed impact). BOTTOM LINE: Bennett fractures are 'simple' two-part fractures with excellent prognosis if treated surgically - Rolando fractures are severe comminuted injuries with guarded prognosis.

Question 2

Why do Bennett fractures almost always need surgery when other small hand fractures can be casted?

Accepted Answer

Bennett fractures are INHERENTLY UNSTABLE due to anatomy and biomechanics - even perfectly reduced (aligned) in cast, they almost always slip back out of position. WHY UNSTABLE: (1) MUSCLE FORCES: Abductor pollicis longus muscle (attaches to base of thumb metacarpal) constantly pulls main fracture fragment proximally (toward wrist) and radially (toward radius side) - this deforming force present 24/7, overwhelms cast's ability to hold reduction | (2) LIGAMENT ATTACHMENT: Small triangular fragment remains attached to trapezium (wrist bone) by very strong volar oblique ligament - this fragment stays in correct position while main shaft displaces, creating step-off in joint surface | (3) JOINT FORCES: Thumb CMC joint is saddle-shaped allowing wide range of motion - any thumb movement (even in cast) generates forces across fracture site promoting displacement | (4) SMALL CONTACT AREA: Fracture typically diagonal/oblique with minimal bony contact between fragments - unstable configuration. STUDIES SHOW: 50-70% of Bennett fractures treated with cast alone lose reduction (fracture shifts out of alignment) even when initially well-reduced - leads to: Articular step-off (uneven joint surface causes abnormal cartilage loading and early arthritis), Thumb CMC subluxation (partial dislocation weakens pinch grip), Loss of thumb length (affects function). SURGICAL FIXATION OVERCOMES FORCES: Pins/screws counteract muscle pull, hold fragments together preventing displacement - allows healing in anatomic position preserving joint congruity. CONTRAST WITH STABLE FRACTURES: Most small hand fractures (finger fractures, metacarpal shaft fractures) are relatively stable - either no muscle forces pulling fragments apart, or fracture pattern inherently stable (transverse, impacted) - these CAN be successfully casted. EXCEPTION: Truly non-displaced Bennett fractures (less than 1mm articular step-off, no subluxation) MAY be treated non-surgically with close monitoring - but threshold for surgery low because consequences of malunion (arthritic thumb) severe. BOTTOM LINE: Bennett fractures require surgery not because they're severe injuries, but because anatomy makes them biomechanically unstable in cast - surgery prevents long-term arthritis and thumb dysfunction.

Question 3

After Bennett fracture surgery with pins, when can I use my hand again and what does the recovery process look like?

Accepted Answer

RECOVERY TIMELINE after closed reduction and percutaneous pinning (CRPP - most common treatment): WEEKS 0-4: Thumb spica cast or splint holds wrist and thumb - pins exit through skin (cut short, covered by cast padding) - NO thumb use, keep cast dry and elevated to reduce swelling - attend follow-up at 1-2 weeks for wound check and X-rays to confirm fracture alignment maintained - pain usually well-controlled with paracetamol/ibuprofen after first week - fingers (index/middle/ring/little) should be exercised regularly to prevent stiffness. WEEKS 4-6: Cast may be shortened (remove forearm portion, keep thumb portion) OR continue full cast depending on fracture healing on X-rays - at 4-6 weeks, pins removed in clinic (quick procedure - doctor cuts wires at skin and pulls them out, no anesthesia needed, mild discomfort for 5-10 seconds) - after pin removal, cast removed and hand therapy started. WEEKS 6-8: Removable thumb splint worn between exercises - hand therapist teaches: Gentle range of motion (thumb flexion/extension, opposition to fingertips), Scar massage (if any pin site scarring), Edema control (compression, elevation) - light activities permitted (typing, writing, eating) but NO forceful gripping/pinching yet. WEEKS 8-12: Progressive strengthening with hand therapy - putty exercises, light grip strengthening, thumb opposition exercises - transition from splint to taping for support - return to light work activities, driving (if safe), most daily activities. WEEKS 12-16 (3-4 MONTHS): Continue strengthening - return to unrestricted activities including sports, manual work when: Full pain-free range of motion achieved, Grip strength 80%+ of opposite hand, X-rays show complete fracture healing - some patients cleared earlier (10-12 weeks) if healing excellent, others need longer if stiffness persists. LONG-TERM: Thumb may feel stiff in mornings or with weather changes for 6-12 months - occasional mild aching at fracture site normal for up to 1 year - final outcome usually excellent with near-normal or normal thumb function. RETURN TO SPECIFIC ACTIVITIES: Driving: 6-8 weeks | Office work: 6-8 weeks | Manual labor: 12-16 weeks | Contact sports: 12-16 weeks | Racquet sports: 10-14 weeks.

Medical Disclaimer

Thumb Base Fractures (Bennett and Rolando Fractures)

📖What is Thumb Base Fractures (Bennett and Rolando Fractures)?

🔬What Causes It?

⚠️Risk Factors

You may be at higher risk if:

🛡️Prevention