Fractures and Dislocations

Abstract

The thumb has the most important role in terms of hand function because of the thumb’s unique orientation. Among the three joints in the thumb, the trapeziometacarpal joint, the key joint of the thumb, gives movements in three planes with the unique anatomy. Some residual deformities from extra-articular thumb fractures are more acceptable than the deformity of the other fingers. Rotational deformity rarely induces a disability. Less than 15–20° of angular deformities in the coronal plane or less than 20–30° in the sagittal plane usually are acceptable and cause no functional deficit. However, intra-articular fractures should be critically treated with the goal of anatomic joint reduction to avoid stiffness and pain with post-traumatic arthritis. In cases with intra-articular fractures of the thumb metacarpal base, surgical fixation is needed because poor outcomes have been reported with casting alone even after good initial reduction. Most traumatic dislocations of the thumb can be treated nonoperatively via closed reduction and immobilization. However, surgical treatment is necessary if the joint is not concentrically reduced or unstable after reduction.