Bennett Fractures, Rolando Fractures, and Guest Lecturer Sam!
Nov 3, 2024
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The hosts dive into the complexities of Bennett and Rolando fractures, offering insights on treatment options and the surgical techniques needed for proper management. They explore intriguing case studies from college football players, blending humor with medical discussions. The conversation also touches on ulnar shortening osteotomy and TFCC debridement, highlighting their effectiveness for wrist issues. Personal anecdotes add a light-hearted twist, making complex orthopedic topics accessible and engaging.
Bennett and Rolando fractures differ significantly in their complexity and treatment approaches, necessitating careful assessment for optimal management.
Effective surgical techniques and post-surgical strategies are critical to ensuring proper healing and successful return to activity for athletes.
Deep dives
Understanding Bennett and Rolando Fractures
Bennett fractures are defined as intra-articular fractures at the base of the thumb metacarpal, characterized by a fragment that remains attached by the anterior oblique ligament. The ligament’s integrity means the fracture fragment stays in place, although the metacarpal is misaligned due to the pull of the abductor pollicis longus tendon. In contrast, the more complex Rolando fractures consist of multiple fragments resembling a 'Y' shape, necessitating surgical intervention due to their intricate nature. Both types of fractures require careful assessment and differentiated treatment approaches, especially with regards to managing their stability and potential complications.
Surgical Approaches and Techniques
In dealing with complex fractures, especially when they present as comminuted fractures rather than straightforward Bennett fractures, surgical techniques become vital. The episode discusses the use of K-wires for stabilization, emphasizing their effectiveness in managing challenging cases by providing structural support. For Bennett fractures, typically closed reduction followed by pinning may suffice, while Rolando fractures usually require more robust fixation techniques like Open Reduction and Internal Fixation (ORIF). Surgeons should also consider a conservative approach post-surgery, like casting and K-wire removal, while monitoring for proper healing to facilitate athletes' safe return to activity.
Post-operative Expectations and Recovery
Post-traumatic arthritis is a notable concern when treating Bennett and Rolando fractures, but the podcast emphasizes that many surgeons have not observed significant issues long-term in their patients. Both surgeons discuss protocols about when athletes can return to play post-injury, which typically involves a waiting period until K-wires are removed and adequate healing has occurred. They suggest using a 'playing cast' strategy to allow some mobility while still maintaining joint stability. Clear communication with patients about the recovery timeline and management of expectations can significantly influence overall satisfaction with the surgical outcome.
Listener Questions and Clinical Insights
Throughout the episode, listener feedback is acknowledged, particularly inquiries about aspects like the management of trigger finger post-surgery. The surgeons respond to a question regarding the implications of flexor tendon bowstringing, noting that while it may offer initial mechanical advantages, it can hinder full range of motion. They also explore the role of debridement versus ulnar shortening osteotomy in treating wrist issues, with one surgeon advocating for shortening due to its higher success rate in alleviating wrist pain. This interaction illustrates the podcast’s commitment to addressing real-world concerns and sharing valuable clinical insights with its audience.
Chuck and Chris discuss Bennett Fractures and Rolando Fractures as well as a few mailbag topics including central TFCC tears (and the role of ulnar shortening) and more on bowstringing from Sam Moghtaderi.
A few citations courtesy of loyal listener Joe McLaughlin. 1) Hulsizer, et al. Ulna- shortening osteotomy after failed arthroscopic debridement of the TFCC. JHS, 1997 2) Nishizuka, et al Simple debridement has little useful value on the clinical course of recalcitrant ulna wrist pain. The Bone Joint Journal, 2013 3) Kim and Song, A comparison of ulnar shortening osteotomy alone vs combined arthroscopic TFCC debridement and ulnar shortening osteotomy for ulnar impaction syndrome. Clinics in Orthopedic Surgery, 2011
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As always, thanks to @iampetermartin for the amazing introduction and conclusion music.
Complete podcast catalog at theupperhandpodcast.wustl.edu.
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