JHS - 2026-03-20 - Journal Article; Review
Thumb Fractures and Associated Injuries: An Evidence Based Review to Guide Treatment.
Yang BW, Kamal RN, Shapiro LM
Topics
Key Takeaway
Bennett fractures with >1-2 mm articular displacement and Rolando fractures with >2 mm step-off benefit from surgical fixation, while extra-articular thumb metacarpal fractures tolerate up to 30° angulation nonoperatively due to CMC compensatory motion.
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Summary
This evidence-based review synthesizes treatment strategies for the full spectrum of thumb fractures—extra-articular metacarpal and phalangeal fractures, Bennett fractures, Rolando fractures, and associated UCL/RCL injuries of the MCP joint. Extra-articular fractures tolerate greater deformity given CMC compensatory motion, whereas intra-articular fractures with >1-2 mm displacement favor surgical restoration of articular congruity. UCL and RCL injuries are stratified by Stener lesion presence and displacement to guide operative versus nonoperative management.
Key Limitation
As a narrative review without a registered protocol or meta-analytic pooling, the absence of quantitative synthesis means treatment thresholds cited (e.g., 1-2 mm displacement) are not derived from aggregated outcome data and may reflect expert opinion rather than high-level evidence.
Original Abstract
Fractures of the thumb encompass a diverse spectrum of injury patterns, each requiring nuanced consideration of various treatment strategies. Associated conditions include injuries to the ulnar collateral ligament and radial collateral ligament of the metacarpophalangeal joint, which can significantly impact thumb stability and function. Although extra-articular fractures of the thumb metacarpal and phalanges are more tolerant of residual deformity due to compensatory movement of the carpometacarpal joint, intra-articular fractures, including Bennett and Rolando fractures, often benefit from surgical intervention to restore articular congruity. This review provides an updated analysis of the treatment and fixation options for thumb fractures and associated ligamentous injuries.