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Comminuted Rolando's fractures: treatment with modified wrist external fixator and transmetacarpal pinning.

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 modified implants and the outcome in the management of comminuted Rolando's fracture.


MATERIAL AND METHOD
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.