![]() ![]() Whilst at first glance we initially thought the patient had undergone a prior trapeziectomy, the trapezium was more visible on the anteroposterior view. Plain x-rays (Figures (Figures1a, 1a, ,1b) 1b) showed a mildly comminuted fracture of the base of the first metacarpal, with a somewhat obscured view of the trapezium on the lateral and resulting apparent loss of the trapezio-metacarpal articulation. The patient has given informed consent for this report.Ī 64-year-old male patient fell from his bicycle onto his right hand, resulting in an axial loading force and hyperabduction of the thumb. The patient is right-hand dominant with no underlying comorbidities and presented to our clinic three weeks later. He only presented because of continuing but intermittent pain in his thumb though he was functionally well preserved. His main concern was the possibility of a disruption to his clerical duties, and his hobby of painting if the pain did not resolve completely. On examination, there was minimal swelling of the hand, no tenderness, and an unrestricted range of motion of the thumb. This case proved a diagnostic and therapeutic dilemma and was eventually managed non-operatively with good functional outcomes. Here we present a case of a misleading plain radiograph of a base of thumb comminuted fracture, with the full extent of injury only fully appreciated on a CT scan. However, they are generally unstable and are often managed operatively, though this remains controversial. Thumb metacarpal fractures are more tolerant of rotation and angulation than other fingers due to compensation from the adjacent joints. As in other fractures, they can be classified as extra or intra-articular, with common fracture patterns of the latter including Bennett’s and Rolando fractures, and comminuted fractures often being treated as a severe form of Rolando fracture. Fractures of the base of the first metacarpal are common and occur after axial overloading along the shaft causing compression of the first carpometacarpal joint (CMCJ). ![]()
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