Comminuted Rolando’s Fractures: Treatment with Modified Wrist External Fixator and Transmetacarpal Pinning
Sunyarn Niempoog MD*, Thanapong Waitayawinyu MD*
Affiliation : * Hand and Microvascular Surgery, Department of Orthopaedic Surgery, Faculty of Medicine, Thammasat University
Background : For comminuted Rolando’s fracture, external fixation with early mobilization is the treatment of
choice however, there is controversy in this treatment. Low-profile or mini external fixator can be used, but
expense and availability of this kind of implant in Thailand has resulted in using various techniques of
surgery. The purpose of this retrospective study was to present the authors’ alternative technique with modi-
fied implants and the outcome in the management of comminuted Rolando’s fracture.
Materials and Methods : The patients with comminuted Rolando’s fracture were treated by using external
fixation across the wrist (mostly by locally-made implants) between the radius and the first metacarpal and
transmetacarpal K-wire fixation from the first to the second metacarpal.
Results : Between 1999 and 2005, six patients with a mean age of 25 years (range, 19-33 years) were studied.
The average follow-up period was four months. Satisfactory reductions were achieved in all fractures. The
average operation time was 27.5 minutes. All closed fractures united within six weeks and had satisfactory
results, which was normal range of motion of thumbs and wrists and with no complications. Only one opened
fracture caused by a gun shot injury was healed in eight weeks and had a mild degree of reflex sympathetic
dystrophy.
Conclusion : Closed reduction and external fixation with modified wrist external fixator and transmetacarpal
pinning is simple, safe, fast, and effective for the treatment of comminuted Rolando’s fractures.
Keywords : Rolando’s fracture, External fixator
