Bennett and Rolando fractures are two common types of thumb fractures that have a significant impact on hand function, affecting the thumb’s crucial role in grip and dexterity.
Both involve the base of the first metacarpal, but they differ in their characteristics, mechanisms of injury, and treatment approaches.
Comparative Overview
Below is the difference between Bennett Fracture and Rolando Fracture in tabular format.
Feature | Bennett Fracture | Rolando Fracture |
Fracture Type | Single, oblique fracture-dislocation | Comminuted, intra-articular fracture |
Mechanism of Injury | Axial load on partially flexed thumb | High-energy trauma |
Fragment Characteristics | Small fragment at metacarpal base | Multiple fragments forming "Y" or "T" |
Clinical Presentation | Pain, swelling, limited motion | Severe pain, swelling, deformity |
Common Treatment Options | Closed reduction, percutaneous pinning, ORIF | External fixation, ORIF, arthrodesis |
Prognosis | Generally good, some stiffness possible | Guarded, higher risk of arthritis |
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Bennett Fracture
A Bennett fracture is a fracture-dislocation of the base of the first metacarpal (The bone connecting the thumb to the wrist) involving the CMC joint. It is typically characterized by a single, oblique fracture line that separates a small fragment of the metacarpal base, which remains attached to the trapezium by the volar beak ligament.
Cause Of injury
Bennett fractures usually occur due to a forceful axial load applied to a partially flexed thumb.
Common situations include:
- Sports injuries (e.g., falling onto an outstretched hand while gripping an object)
- Direct trauma (e.g., punching).
Symptoms
- Pain and swelling at the base of the thumb
- Difficulty in Movement
- Visible deformity or angulation
Treatment
Bennett fractures often require surgical procedures to restore joint congruity and stability. Treatment options include:
- Closed Reduction and Percutaneous Pinning: Aligning the fracture manually and inserting pins to maintain alignment.
- Open Reduction and Internal Fixation (ORIF): Surgically exposing the fracture site to directly visualise and fixate the bones using screws and plates.
Prognosis
With appropriate treatment, patients can expect a good outcome, but some stiffness and arthritis risk may persist.
Rolando Fracture
It is an intra-articular three-part or comminuted fracture of the base of the first metacarpal. It consists of multiple fracture fragments, typically forming a "Y" or "T" shape.
Cause of injury
- Severe pain and swelling at the base of the thumb
- Noticeable deformity
- Significant loss of thumb motion
Treatment
Since its complex surgical treatment is almost always necessary. Options include:
- External Fixation: Stabilising the fracture with an external frame.
- ORIF: Aligning and fixing the multiple fragments with screws and plates.
- Arthrodesis: Fusing the joint in severe cases to relieve pain and maintain stability.
Prognosis
Rolando fractures have a more guarded prognosis compared to Bennett fractures due to the complexity of the injury and higher risk of post-traumatic arthritis and stiffness.
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Similarities and differences between Bennett and Rolando
Similarities
- Location: Both involve the base of the first metacarpal.
- Mechanism: Typically result from high-energy trauma.
- Symptoms: Pain, swelling, limited thumb motion.
- Diagnosis: Physical examination, X-rays, and sometimes CT scans.
- Treatment: Often requires surgical intervention.
Differences:
- Fracture Type: Bennett is a single oblique fracture-dislocation; Rolando is a comminuted intra-articular fracture.
- Fragment Pattern: Bennett has a single fragment; Rolando has multiple fragments forming "Y" or "T" shapes.
Prognosis
Bennett generally has a better prognosis with less risk of arthritis; Rolando has a more guarded prognosis.
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