{"paper_id":"4ba6df28-b628-4abd-9500-3204b4e3bd49","body_text":"Hooked Embracing Plate for Rolando Fracture Fixation: A Preliminary Result | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Hooked Embracing Plate for Rolando Fracture Fixation: A Preliminary Result Yueh-Ju Tsai, Jui-Po Yeh, Tsen-Hung Lin, Tsan-Shiun Lin, Ching-Hua Hsieh This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2172154/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Background Rolando fracture is a comminuted, intra-articular fracture over the metacarpal bone base of the thumb which often leads to joint instability and requirement of surgery. The aim of this study is to evaluate the radiological and functional outcomes of Rolando fracture following surgical fixation with a hooked embracing plate designed for Rolando fracture. Method We retrospectively reviewed a consequence of patients between 2018 to 2022 with Rolando fracture who received open reduction internal fixation with hooked embracing plates. Primary endpoints were the quality of radiologic reduction after the operation and peri-operative complications. Secondary outcomes were bone union, pinch and grip strength, palmar abduction, opposition and radiographic osteoarthritis over the trapeziometacarpal (TMC) joint. Results A total of 5 patients were included. All patients had good quality of radiological reduction without peri-operative complications. The opposition, abduction, pinch and grip strength were nearly full-recovered for all patients with fine bone unions after 3 months follow-up. Conclusion The hooked embracing plate is a good and safe option for surgical fixation in patients with Rolando fracture. Compared with traditional method such as lag screw or mini-plate fixation, the hooked embracing plate could provide rigid fixation with fine radiologic and functional outcomes with early mobilization. Rolando fracture thumb metacarpal base fracture hooked embracing plate hook plate Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Introduction Rolando fracture was firstly described by Silvio Rolando, an Italian surgeon, in 1910( 1 ). It is classically a three-part, intra-articular fracture over the base of thumb metacarpal, which is described as “T” or “Y” morphologies( 2 ). The term has become to generally indicate intra-articular, comminuted fracture with 3 or more segments over the base of thumb metacarpal bone( 3 ). The injury is typically caused by compressive forces along the axis of the metacarpal bone while the trapeziometacarpal (TMC) joint in flexion( 4 ). The fracture would often lead to subluxation or instability of the TMC joint due to the tension force of the abductor pollicis longus (APL) tendon( 5 ). Surgical treatment is often needed due to its intrinsic instability( 6 ). The goal of treatment for Rolando fracture is to achieve anatomical reduction, perform stable fixation for early mobilization, optimize range of motion of the TMC joint, and to minimize pain( 7 , 8 ). However, treatment is relatively difficult due to its intrinsic nature of instability and comminuted patterns, and complications as loss of reduction, joint incongruity or osteoarthritis could happen( 4 , 9 ). The hook plate system was originated for mallet finger with small avulsed fragments( 10 ). Later, a hooked embracing plate (Acumed, 1.3mm, Rolando Fracture Hooked Plate) was designed for intra-articular fracture over the base of the thumb metacarpal bone. However, few studies compare outcomes between the hook embracing plate and the traditional method (either lag screw or mini-plate) for patients with Rolando fracture receiving open reduction internal fixation. Therefore, we would like to share our experience on the hook embracing plate for Rolando fracture, and to evaluate the radiological and functional outcomes of our patients. Patients And Methods We retrospectively reviewed five patients with classic Rolando fracture or intra-articular comminuted fracture over base of thumb metacarpal bone from January 2018 to October 2022 in our hospital. All patients received open reduction internal fixation via a hooked embracing plate. The hooked embracing plate (Fig. 1 ) was produced by Acumed company as hand and wrist plating system. The study was approved by the Chang Gung Medical Foundation Institutional Review Board (CGMF-IRB, No.202101329B0). Patient demographics (age, sex, body mass index), underlying diseases, injury mechanisms and sites, fracture patterns, operations, and interval of mobilization were collected from medical records. The follow up was a minimum of 3 months. Primary outcomes were radiologic reduction after the operation and peri-operative complications including infection, neurovascular damage or loss of reduction. Secondary outcomes were bone union, palmar abduction, opposition according to Kapandji score( 11 ), pinch and grip strength of the injured finger and radiographic osteoarthritis assessed by the Eaton-Littler classification( 12 ). SURGICAL INDICATION AND TECHNIQUE Hook embracing plate was recommended for patients with classic Rolando fracture and intra-articular, comminuted fracture over base of thumb metacarpal, just if the fracture bone segments were large enough for fixation. Patients with open fracture was excluded for the usage of the plate. All patients in our study received general anesthesia. A dorsal, straight incision was made over the base of thumb metacarpal bone( 13 ) (Fig. 2). The sensory brach of radial nerve and radial artery was carefully protected during exploration of the wound( 14 ). The dissection went between the abductor pollicis longus and the extensor pollicis brevis tendon to disclose the metacarpal base( 15 ). The periosteum was opened with a sharp scalpel longitudinally and dissected carefully to exposed the fracture segments. Dissection would be stopped when getting close to the TMC joint to preserve the surrounding tissue of the joint capsule, such as connective tissue and ligamentous structure. We believed that this could also do less damage on the TMC joint leading to deterioration of joint instability. The fracture segments were identified clearly, and to fragile pieces were removed. Traction force might help while doing the thumb reduction. Furthermore, stabilization of the basilar fracture segments was achieved with assistance of a temporary K-wire or reduction forceps( 4 , 9 ). The 1.3 mm Rolando Fracture Hook Plate was then placed on the metacarpal bone for fixation. The hook on the proximal aspect of the plate was positioned onto the metacarpal base. A 2.3mm lag screw would be inserted for inter-fragmentary fixation if it was applicable. The embraced arm portion of the plate was fixed to the basilar segments of the metacarpal bone with 1.5mm screws. The metacarpal shaft was then fixed to the long portion of the hook plate with 1.5mm screws. The periosteum was repaired to cover the hook plate. The skin was closed with Nylon sutures. A thumb spica splint was used for immobilization. Results Five patients, including 3 males and 2 females, were documented with an average age of 40.8 years old (IQR 41.0 years old) (Table 1 ). All patients were injured due to a traffic accident. Four of the patients suffered from classic Rolando fractures with a three-part fragments, while the remaining one suffered from intra-articular, comminuted fracture over the base of thumb metacarpal bone. All fractures were close fracture. The average interval from injury to operation was 2.4 days (IQR 1.5 days). All patients underwent open reduction internal fixation with a hook embracing plate by dorsal approach. The average interval from operation to mobilization was 11.6 days (IQR 2.0 days). The average follow-up time was 8 months (IQR 12.0 months). All our patients achieved excellent radiologic reduction (Table 2 ). Joint incongruity was less than 1mm in three of our patients, and around 1-2mm in one of our patient. No joint subluxation happened. All patients had an acceptable angulation of less than 15 degree. No peri-operative complications including infection, neurovascular damage or loss of reduction were noted. Fine bone union was noted for all our patients after 3 months follow-up. All patients regained full opposition except one with a minimal disparity (Kapandji score 9/10) (Table 3 ). Abduction was good in three patients (> 45 degree) and fair in one case (30–45 degree). No significant difference in pinch and grip strength compared with the uninjured hand was noted except in one patient. Only one patient had a stage 1 Eaton-Littler radiographic osteoarthritis. All patients returned to their previous daily work and activities. Only one patient asked for removal of plate due to irritation after 20 months of surgery. Table 1 Summary of cases Case Age/ Sex Injury mechanism Fracture site Open/ close Pattern Approach Operation Mobilization interval (day) 1 56/ M TA, contusion Right thumb, metacarpal base Close Rolando Dorsal, straight incision ORIF, hook plate 12 2 74/F TA, contusion Right thumb, metacarpal base Close Comminuted, intra-articular Dorsal, straight incision ORIF, hook plate 13 3 26/ M TA, contusion Left thumb, metacarpal base Close Rolando Dorsal, straight incision ORIF, hook plate 12 4 26/ F TA, contusion Right thumb, metacarpal base Close Rolando Dorsal, straight incision ORIF, hook plate 11 5 22/ M TA, contusion Right thumb, metacarpal base Close Rolando Dorsal, straight incision ORIF, hook plate 10 * M, male. F, female. TA, traffic accident. ORIF, open reduction internal fixation. Table 2 Primary Outcomes Case Radiologic outcomes Peri-operative complications Joint incongruity Subluxation Angulation Infection Neurovascular damage Loss of reduction 1 < 1mm (-) < 15 degree (-) (-) (-) 2 1-2mm (-) < 15 degree (-) (-) (-) 3 < 1mm (-) < 15 degree (-) (-) (-) 4 < 1mm (-) < 15 degree (-) (-) (-) 5 < 1mm (-) < 15 degree (-) (-) (-) Table 3 Secondary outcomes* Pinch and grip strength, pinch and grip strength as the percentage of the contralateral values. OA, osteoarthritis Case Bone union (at 3 month) Functional outcomes Radiographic oteoarthritis (Eaton-Littler classification) Opposition (Kapandji score) Abduction (degree) Pinch and grip strength 1 (+) 10/10 > 45 100 (-) 2 (+) 9/10 30–45 80 Stage 1 3 (+) 10/10 > 45 100 (-) 4 (+) 10/10 > 45 100 (-) 5 (+) 10/10 > 45 90 (-) CASES PRESENTATION CASE 1 A 26-year-old male patient (patient 3) was brought to the emergency department because of close, Rolando fracture over left hand due to contusion in a traffic accident (Fig. 3 ). He received open reduction internal fixation via dorsal approach with a hooked embracing plate 2 days after the injury. No peri-operative complications as infection or neurovascular damage was noted. The interval from operation to mobilization was 12 days. Radiologic reduction showed an excellent result after 20 days of surgery (Fig. 4). The left thumb achieved fine functional outcomes of range of motion after 5 weeks follow-up (Fig. 5). CASE 2 A 74-year-old female patient (patient 2) suffered from Rolando fracture over right hand due to a traffic accident (Fig. 6 ). She underwent open reduction internal fixation with a hooked embracing plate 3 days after the injury. There were no peri-operative complications nor neuromuscular damage after surgical intervention. The interval from operation to mobilization was 13 days. Radiologic reduction showed a good result after 17 days of surgery (Fig. 7 ). The opposition, fingers pinch, flexion and extension of right thumb were all good without disabilities after 4 months follow-up (Video 1). Discussion Conservative treatment with splinting or close reduction with percutaneous pinning seems to have poor reduction and functional outcomes in previous studies( 15 – 17 ). For Rolando fracture with large segments, open reduction with internal fixation via either lag screw or mini-plate is preferable( 2 , 4 , 6 , 14 ). A hook embracing plate (Acumed, 1.3mm, Rolando Fracture Hooked Plate) was introduced for Rolando fracture but with few evidence. In our study, all our patients achieved excellent radiologic reduction, fine bone union, good hand function after surgery with a hook embracing plate. Comparing with lag screw or mini-plate according to previous studies( 8 , 9 ), both the radiologic and functional results were non-inferior with earlier mobilization. No significant peri-operative complications including infection, neurovascular damage or loss of reduction were noted in our patients. Restoration of articular surface is relative important( 8 , 9 ). However, several studies did not found a strong relation between joint incongruity and osteoarthritis( 2 , 18 ). Despite that, one of our patients with a post-operative joint incongruity around 1-2mm suffered from a mild radiographic osteoarthritis without significant disability. Therefore, anatomical reduction should be achieved as possible to prevent such post-operative sequelae. In our experience, the hook design allows an extra-bone-to-connective tissue support by positioned the hook on the ligamentous structure over the metacarpal base. The ligamentous structures around the TMC joint, especially the volar oblique ligament, play a big role in stabilization of the joint( 4 , 5 , 15 ). The extra-support could help further stabilize the fixation and diminish the joint deformity. Besides, the hook design allows us to restore the articular surface easier, preventing excessive bone stripping or joint capsule destruction in order to achieve anatomical reduction. The periosteum and surrounding tissue could be persevered better, and it might be benefit on better circulation for bone union. Besides, the design of embracing arm portion of the plate, we thought the fixation might be more rigid from two dimensions of fixation screws. On the other hand, the price of the hook embracing plate was relative expensive than traditional lag screw or mini-plate, leading to the relative small case number in our studies. Moreover, the technique is demanding and needs high degree of precision. There were a few limitations in our study. First, it was a retrospective study of descriptive characteristic but no comparison with the results from other fixation methods or conservative treatment. Second, the included patient number was relatively small, and the follow-up time was relatively short. Furthermore, few studies had evaluation of the surgical outcomes for Rolando fractures, and most of these studies had a small patient number. Therefore, meaningful comparisons of the outcomes with other studies became much more difficult. Despite of the limitations, we still found that the hooked embracing plate provides fine preliminary result in patients with Rolando fracture, even in elder people with possible risks of osteoporosis. This method may provide more confidence of surgical fixation for post-operative early mobilization which also may contribute the better results. Therefore, open reduction via hooked embracing plate shall be considered as a better solution for Rolando fracture. Meanwhile, we can also design prospective studies with more detail comparison for further follow-up. Conclusion The hooked embracing plate is a good and safe option for surgical fixation in patients with Rolando fracture. Compared with traditional method such as lag screw or mini-plate fixation, the hooked embracing plate could provide non-inferior radiologic and functional outcomes with fine bone union and earlier mobilization. Declarations Ethics approval and consent to participate The study was approved by the Chang Gung Medical Foundation Institutional Review Board (CGMF-IRB, No.202101329B0). All methods were carried out in accordance with relevant guidelines and regulations. Besides, according to Chang Gung Medical Foundation Institutional Review Board (CGMF-IRB), the informed consent for participate was waived because our study was a retrospective study analyzing the clinical outcomes of our patients based on medical records. The participants in our study had the lowest risk, and the risk of participants was no more than non-participants. Consent for publication Not applicable. Availability of data and materials All data generated or analyzed during this study are included in this published article. Competing interests The authors declare that they have no competing interests. Funding The authors declare that they have no funding. Authors' contributions YJ Tsai and JP Yeh wrote the main manuscript text. YJ Tsai, TH Lin and TS Lin provided patient data. All authors reviewed the manuscript. Acknowledgements Not applicable. References Rolando S. Fracture of the base of the first metacarpal and a variation that has not yet been described. 1910. Clin Orthop Relat Res. 1996(327):4–8. Langhoff O, Andersen K, Kjaer-Petersen K. Rolando's fracture. J Hand Surg Br. 1991;16(4):454–9. Hong E. Hand injuries in sports medicine. Prim Care. 2005;32(1):91–103. Sood A, Granick MS. Rolando fracture. Eplasty. 2014;14:ic16. McCann MR, Rust PA, Wallace R. The Stabilising Effect of the Anterior Oblique Ligament to Prevent Directional Subluxation at the Trapeziometacarpal Joint of the Thumb: A Biomechanical Cadaveric Study. Arch Bone Jt Surg. 2018;6(2):105–11. Brown MT, Rust PA. Fractures of the thumb metacarpal base. Injury. 2020;51(11):2421–8. Eaton RG, Lane LB, Littler JW, Keyser JJ. Ligament reconstruction for the painful thumb carpometacarpal joint: a long-term assessment. J Hand Surg Am. 1984;9(5):692–99. Uludag S, Ataker Y, Seyahi A, Tetik O, Gudemez E. Early rehabilitation after stable osteosynthesis of intra-articular fractures of the metacarpal base of the thumb. J Hand Surg Eur Vol. 2015;40(4):370–3. Mumtaz MU, Ahmad F, Kawoosa AA, Hussain I, Wani I. Treatment of Rolando Fractures by Open Reduction and Internal Fixation using Mini T-Plate and Screws. J Hand Microsurg. 2016;8(2):80–5. Teoh LC, Lee JY. Mallet fractures: a novel approach to internal fixation using a hook plate. J Hand Surg Eur Vol. 2007;32(1):24–30. Kapandji A. [Clinical test of apposition and counter-apposition of the thumb]. Ann Chir Main. 1986;5(1):67–73. Eaton RG, Glickel SZ. Trapeziometacarpal osteoarthritis. Staging as a rationale for treatment. Hand Clin. 1987;3(4):455–71. Cantero J. [Bennett's fracture-luxation. Osteosynthesis by the dorsal approach]. Ann Chir Main. 1984;3(2):165–7. Foster RJ, Hastings H 2nd. Treatment of Bennett, Rolando, and vertical intraarticular trapezial fractures. Clin Orthop Relat Res. 1987(214):121–9. Liverneaux PA, Ichihara S, Hendriks S, Facca S, Bodin F. Fractures and dislocation of the base of the thumb metacarpal. J Hand Surg Eur Vol. 2015;40(1):42–50. Vichard P, Tropet Y, Nicolet F. Longitudinal pinning of fractures of the base of the first metacarpal. Ann Chir Main. 1982;1(4):301–6. van Niekerk JL, Ouwens R. Fractures of the base of the first metacarpal bone: results of surgical treatment. Injury. 1989;20(6):359–62. Leclère FM, Jenzer A, Hüsler R, Kiermeir D, Bignion D, Unglaub F, et al. 7-year follow-up after open reduction and internal screw fixation in Bennett fractures. Arch Orthop Trauma Surg. 2012;132(7):1045–51. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Major revision 09 Nov, 2022 Reviews received at journal 06 Nov, 2022 Reviewers agreed at journal 04 Nov, 2022 Reviewers invited by journal 04 Nov, 2022 Editor assigned by journal 04 Nov, 2022 Editor invited by journal 03 Nov, 2022 Submission checks completed at journal 03 Nov, 2022 First submitted to journal 16 Oct, 2022 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-2172154\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":false,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":149127774,\"identity\":\"cbac042c-0773-47ea-9253-a773ad5c15a5\",\"order_by\":0,\"name\":\"Yueh-Ju Tsai\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Kaohsiung Chang Gung Memorial Hospital\",\"correspondingAuthor\":false,\"submittingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Yueh-Ju\",\"middleName\":\"\",\"lastName\":\"Tsai\",\"suffix\":\"\"},{\"id\":149127775,\"identity\":\"5d36fe2d-248c-4733-99d5-a0c603a92983\",\"order_by\":1,\"name\":\"Jui-Po Yeh\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Kaohsiung Chang Gung Memorial Hospital\",\"correspondingAuthor\":false,\"submittingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Jui-Po\",\"middleName\":\"\",\"lastName\":\"Yeh\",\"suffix\":\"\"},{\"id\":149127776,\"identity\":\"6489e7a3-36d8-426c-ba2a-11ebb8748670\",\"order_by\":2,\"name\":\"Tsen-Hung Lin\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Kaohsiung Chang Gung Memorial Hospital\",\"correspondingAuthor\":false,\"submittingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Tsen-Hung\",\"middleName\":\"\",\"lastName\":\"Lin\",\"suffix\":\"\"},{\"id\":149127777,\"identity\":\"ae9a9e92-60d7-4520-b371-2b5b7c46e447\",\"order_by\":3,\"name\":\"Tsan-Shiun Lin\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Kaohsiung Chang Gung Memorial Hospital\",\"correspondingAuthor\":false,\"submittingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Tsan-Shiun\",\"middleName\":\"\",\"lastName\":\"Lin\",\"suffix\":\"\"},{\"id\":149127778,\"identity\":\"4da926c3-516f-460f-b6af-7d1d7572d7dd\",\"order_by\":4,\"name\":\"Ching-Hua Hsieh\",\"email\":\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8ElEQVRIiWNgGAWjYDAC9vYDzAwGDCDE+ADI5+EjqIXnTAJMC7MBiM9GUItEggEziAYqZ5MAMQhq0Z2RkPi5oOCO3XaJ5GeVX3PsZNgYmB8+uoFHi9mZh4elZxg8S945I83stuy2ZKDD2IyNc/BpOZ6QxsxjcDjZ4EaC2W3JbcxALTxs0ni1HEgwg2pJ/1Ysua2eCC0nIFrsDG7kmDF+3HaYCC1nziRLA7UkGJx5UyzNuO04DxszQb+0H/zM8+ewvcHx9I0ff26rtudnb374GJ8WGEhsABLMPCAmMxHKQcAeRDD+IFL1KBgFo2AUjCwAAEQySUi/6XtlAAAAAElFTkSuQmCC\",\"orcid\":\"\",\"institution\":\"Kaohsiung Chang Gung Memorial Hospital\",\"correspondingAuthor\":true,\"submittingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Ching-Hua\",\"middleName\":\"\",\"lastName\":\"Hsieh\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2022-10-16 16:59:13\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-2172154/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-2172154/v1\",\"draftVersion\":[],\"editorialEvents\":[],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":28754277,\"identity\":\"e431d819-03ee-42a2-b9e6-bdcc0655cf9e\",\"added_by\":\"auto\",\"created_at\":\"2022-11-07 15:17:28\",\"extension\":\"jpg\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":196678,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eA hooked embracing plate (Acumed, 1.3mm, Rolando Fracture Hooked Plate).\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Fig1.jpg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-2172154/v1/e4e66f0602ab5a06c1a17d85.jpg\"},{\"id\":28754278,\"identity\":\"acc04124-77f0-4896-8770-52f573913137\",\"added_by\":\"auto\",\"created_at\":\"2022-11-07 15:17:28\",\"extension\":\"jpg\",\"order_by\":2,\"title\":\"Figure 2\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":73341,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eSurgical technique. (Left) Pre-operative marking of the metacarpophalangeal (MP) joint, the alignment of the metacarpal bone and the carpometacarpal (CMC) or trapeziometacarpal (TMC) joint. (Right) Intra-operative placement of and fixation of the hook embracing plate.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Fig2.jpg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-2172154/v1/136d829b2ebfd1101d3ec755.jpg\"},{\"id\":28753103,\"identity\":\"476c368d-c728-4959-8596-7e0743854e65\",\"added_by\":\"auto\",\"created_at\":\"2022-11-07 15:09:28\",\"extension\":\"jpg\",\"order_by\":3,\"title\":\"Figure 3\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":79718,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eLeft thumb metacarpal base Rolando fracture. (Left, A-P view) (Right, lateral view)\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Fig3.jpg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-2172154/v1/f907a249b4a12652e9939488.jpg\"},{\"id\":28753108,\"identity\":\"65548650-6c18-47e4-ae2a-ce943d0a8f43\",\"added_by\":\"auto\",\"created_at\":\"2022-11-07 15:09:28\",\"extension\":\"jpg\",\"order_by\":4,\"title\":\"Figure 4\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":77494,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003e(POD 20) ORIF with a hook embracing plate with excellent radiologic reduction. (Left, A-P view) (Right, lateral view) * POD, post-operative day. ORIF, open reduction internal fixation\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Fig4.jpg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-2172154/v1/7af3d6dbba6da6ae6a297e6e.jpg\"},{\"id\":28754276,\"identity\":\"5d8e1fb7-fa30-49b4-bfa8-99cbd5571941\",\"added_by\":\"auto\",\"created_at\":\"2022-11-07 15:17:28\",\"extension\":\"jpg\",\"order_by\":5,\"title\":\"Figure 5\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":95746,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eFine functional outcomes with full opposition was noted over the injured hand after 5 weeks of surgery.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Fig5.jpg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-2172154/v1/676abe1cf1cf06dd3ce27484.jpg\"},{\"id\":28753101,\"identity\":\"f1674846-cced-4dd7-be7f-168ad71dc174\",\"added_by\":\"auto\",\"created_at\":\"2022-11-07 15:09:28\",\"extension\":\"jpg\",\"order_by\":6,\"title\":\"Figure 6\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":69018,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eRight thumb metacarpal base Rolando fracture. (Left, A-P view) (Right, lateral view)\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Fig6.jpg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-2172154/v1/4b8c64cdf44a54996c7778bf.jpg\"},{\"id\":28753104,\"identity\":\"35ae2261-15f9-4648-af2c-deb3ccae4e12\",\"added_by\":\"auto\",\"created_at\":\"2022-11-07 15:09:28\",\"extension\":\"jpg\",\"order_by\":7,\"title\":\"Figure 7\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":82268,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003e(POD 17) ORIF with a hook embracing plate with excellent radiologic reduction. (Left, A-P view) (Right, lateral view) * POD, post-operative day. ORIF, open reduction internal fixation\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Fig7.jpg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-2172154/v1/081292709b956588cedc75df.jpg\"},{\"id\":28754312,\"identity\":\"97ae00ed-0756-42fe-9ec0-2b9a4666dc1c\",\"added_by\":\"auto\",\"created_at\":\"2022-11-07 15:17:33\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":919334,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-2172154/v1/0d3bc00b-48eb-4390-a157-f5ca91a1acad.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Hooked Embracing Plate for Rolando Fracture Fixation: A Preliminary Result\",\"fulltext\":[{\"header\":\"Introduction\",\"content\":\"\\u003cp\\u003eRolando fracture was firstly described by Silvio Rolando, an Italian surgeon, in 1910(\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e). It is classically a three-part, intra-articular fracture over the base of thumb metacarpal, which is described as \\u0026ldquo;T\\u0026rdquo; or \\u0026ldquo;Y\\u0026rdquo; morphologies(\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e). The term has become to generally indicate intra-articular, comminuted fracture with 3 or more segments over the base of thumb metacarpal bone(\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e). The injury is typically caused by compressive forces along the axis of the metacarpal bone while the trapeziometacarpal (TMC) joint in flexion(\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e). The fracture would often lead to subluxation or instability of the TMC joint due to the tension force of the abductor pollicis longus (APL) tendon(\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e). Surgical treatment is often needed due to its intrinsic instability(\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eThe goal of treatment for Rolando fracture is to achieve anatomical reduction, perform stable fixation for early mobilization, optimize range of motion of the TMC joint, and to minimize pain(\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e). However, treatment is relatively difficult due to its intrinsic nature of instability and comminuted patterns, and complications as loss of reduction, joint incongruity or osteoarthritis could happen(\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eThe hook plate system was originated for mallet finger with small avulsed fragments(\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e). Later, a hooked embracing plate (Acumed, 1.3mm, Rolando Fracture Hooked Plate) was designed for intra-articular fracture over the base of the thumb metacarpal bone. However, few studies compare outcomes between the hook embracing plate and the traditional method (either lag screw or mini-plate) for patients with Rolando fracture receiving open reduction internal fixation. Therefore, we would like to share our experience on the hook embracing plate for Rolando fracture, and to evaluate the radiological and functional outcomes of our patients.\\u003c/p\\u003e\"},{\"header\":\"Patients And Methods\",\"content\":\"\\u003cp\\u003eWe retrospectively reviewed five patients with classic Rolando fracture or intra-articular comminuted fracture over base of thumb metacarpal bone from January 2018 to October 2022 in our hospital. All patients received open reduction internal fixation via a hooked embracing plate. The hooked embracing plate (Fig. \\u003cspan class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e) was produced by Acumed company as hand and wrist plating system. The study was approved by the Chang Gung Medical Foundation Institutional Review Board (CGMF-IRB, No.202101329B0).\\u003c/p\\u003e\\n\\u003cp\\u003ePatient demographics (age, sex, body mass index), underlying diseases, injury mechanisms and sites, fracture patterns, operations, and interval of mobilization were collected from medical records. The follow up was a minimum of 3 months. Primary outcomes were radiologic reduction after the operation and peri-operative complications including infection, neurovascular damage or loss of reduction. Secondary outcomes were bone union, palmar abduction, opposition according to Kapandji score(\\u003cspan class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e), pinch and grip strength of the injured finger and radiographic osteoarthritis assessed by the Eaton-Littler classification(\\u003cspan class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e).\\u003c/p\\u003e\\n\\u003cdiv class=\\\"Section2\\\" id=\\\"Sec3\\\"\\u003e\\n \\u003ch2\\u003eSURGICAL INDICATION AND TECHNIQUE\\u003c/h2\\u003e\\n \\u003cp\\u003eHook embracing plate was recommended for patients with classic Rolando fracture and intra-articular, comminuted fracture over base of thumb metacarpal, just if the fracture bone segments were large enough for fixation. Patients with open fracture was excluded for the usage of the plate.\\u003c/p\\u003e\\n \\u003cp\\u003eAll patients in our study received general anesthesia. A dorsal, straight incision was made over the base of thumb metacarpal bone(\\u003cspan class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e) (Fig.\\u0026nbsp;2). The sensory brach of radial nerve and radial artery was carefully protected during exploration of the wound(\\u003cspan class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e). The dissection went between the abductor pollicis longus and the extensor pollicis brevis tendon to disclose the metacarpal base(\\u003cspan class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e). The periosteum was opened with a sharp scalpel longitudinally and dissected carefully to exposed the fracture segments. Dissection would be stopped when getting close to the TMC joint to preserve the surrounding tissue of the joint capsule, such as connective tissue and ligamentous structure. We believed that this could also do less damage on the TMC joint leading to deterioration of joint instability.\\u003c/p\\u003e\\n \\u003cp\\u003eThe fracture segments were identified clearly, and to fragile pieces were removed. Traction force might help while doing the thumb reduction. Furthermore, stabilization of the basilar fracture segments was achieved with assistance of a temporary K-wire or reduction forceps(\\u003cspan class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e, \\u003cspan class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e). The 1.3 mm Rolando Fracture Hook Plate was then placed on the metacarpal bone for fixation. The hook on the proximal aspect of the plate was positioned onto the metacarpal base. A 2.3mm lag screw would be inserted for inter-fragmentary fixation if it was applicable. The embraced arm portion of the plate was fixed to the basilar segments of the metacarpal bone with 1.5mm screws. The metacarpal shaft was then fixed to the long portion of the hook plate with 1.5mm screws. The periosteum was repaired to cover the hook plate. The skin was closed with Nylon sutures. A thumb spica splint was used for immobilization.\\u003c/p\\u003e\\n\\u003c/div\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cp\\u003eFive patients, including 3 males and 2 females, were documented with an average age of 40.8 years old (IQR 41.0 years old) (Table \\u003cspan class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e). All patients were injured due to a traffic accident. Four of the patients suffered from classic Rolando fractures with a three-part fragments, while the remaining one suffered from intra-articular, comminuted fracture over the base of thumb metacarpal bone. All fractures were close fracture. The average interval from injury to operation was 2.4 days (IQR 1.5 days). All patients underwent open reduction internal fixation with a hook embracing plate by dorsal approach. The average interval from operation to mobilization was 11.6 days (IQR 2.0 days). The average follow-up time was 8 months (IQR 12.0 months).\\u003c/p\\u003e\\n\\u003cp\\u003eAll our patients achieved excellent radiologic reduction (Table \\u003cspan class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e). Joint incongruity was less than 1mm in three of our patients, and around 1-2mm in one of our patient. No joint subluxation happened. All patients had an acceptable angulation of less than 15 degree. No peri-operative complications including infection, neurovascular damage or loss of reduction were noted.\\u003c/p\\u003e\\n\\u003cp\\u003eFine bone union was noted for all our patients after 3 months follow-up. All patients regained full opposition except one with a minimal disparity (Kapandji score 9/10) (Table \\u003cspan class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e). Abduction was good in three patients (\\u0026gt;\\u0026thinsp;45 degree) and fair in one case (30\\u0026ndash;45 degree). No significant difference in pinch and grip strength compared with the uninjured hand was noted except in one patient. Only one patient had a stage 1 Eaton-Littler radiographic osteoarthritis. All patients returned to their previous daily work and activities. Only one patient asked for removal of plate due to irritation after 20 months of surgery.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003ctable border=\\\"1\\\" id=\\\"Tab1\\\"\\u003e\\n \\u003ccaption language=\\\"En\\\"\\u003e\\n \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 1\\u003c/div\\u003e\\n \\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\n \\u003cp\\u003eSummary of cases\\u003c/p\\u003e\\n \\u003c/div\\u003e\\n \\u003c/caption\\u003e\\n \\u003cthead\\u003e\\n \\u003ctr\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCase\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eAge/ Sex\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eInjury mechanism\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eFracture site\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eOpen/ close\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003ePattern\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eApproach\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eOperation\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eMobilization interval (day)\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/thead\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e56/ M\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eTA, contusion\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eRight thumb, metacarpal base\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eClose\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eRolando\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eDorsal, straight incision\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eORIF, hook plate\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e12\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e74/F\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eTA, contusion\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eRight thumb, metacarpal base\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eClose\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eComminuted, intra-articular\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eDorsal, straight incision\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eORIF, hook plate\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e13\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e26/ M\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eTA, contusion\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eLeft thumb, metacarpal base\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eClose\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eRolando\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eDorsal, straight incision\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eORIF, hook plate\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e12\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e26/ F\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eTA, contusion\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eRight thumb, metacarpal base\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eClose\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eRolando\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eDorsal, straight incision\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eORIF, hook plate\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e11\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e22/ M\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eTA, contusion\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eRight thumb, metacarpal base\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eClose\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eRolando\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eDorsal, straight incision\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eORIF, hook plate\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e10\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003e* M, male. F, female. TA, traffic accident. ORIF, open reduction internal fixation.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003ctable border=\\\"1\\\" id=\\\"Tab2\\\"\\u003e\\n \\u003ccaption language=\\\"En\\\"\\u003e\\n \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 2\\u003c/div\\u003e\\n \\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\n \\u003cp\\u003ePrimary Outcomes\\u003c/p\\u003e\\n \\u003c/div\\u003e\\n \\u003c/caption\\u003e\\n \\u003cthead\\u003e\\n \\u003ctr\\u003e\\n \\u003cth align=\\\"left\\\" rowspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003eCase\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\" colspan=\\\"3\\\"\\u003e\\n \\u003cp\\u003eRadiologic outcomes\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\" colspan=\\\"3\\\"\\u003e\\n \\u003cp\\u003ePeri-operative complications\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eJoint incongruity\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eSubluxation\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eAngulation\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eInfection\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eNeurovascular damage\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eLoss of reduction\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/thead\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;\\u0026thinsp;1mm\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e(-)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;\\u0026thinsp;15 degree\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e(-)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e(-)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e(-)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1-2mm\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e(-)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;\\u0026thinsp;15 degree\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e(-)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e(-)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e(-)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;\\u0026thinsp;1mm\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e(-)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;\\u0026thinsp;15 degree\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e(-)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e(-)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e(-)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;\\u0026thinsp;1mm\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e(-)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;\\u0026thinsp;15 degree\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e(-)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e(-)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e(-)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;\\u0026thinsp;1mm\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e(-)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;\\u0026thinsp;15 degree\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e(-)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e(-)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e(-)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003e\\u003cbr\\u003e\\u003c/p\\u003e\\n\\u003cdiv class=\\\"gridtable\\\"\\u003e\\n \\u003ctable border=\\\"1\\\" id=\\\"Tab3\\\"\\u003e\\n \\u003ccaption language=\\\"En\\\"\\u003e\\n \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 3\\u003c/div\\u003e\\n \\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\n \\u003cp\\u003eSecondary outcomes* Pinch and grip strength, pinch and grip strength as the percentage of the contralateral values. OA, osteoarthritis\\u003c/p\\u003e\\n \\u003c/div\\u003e\\n \\u003c/caption\\u003e\\n \\u003cthead\\u003e\\n \\u003ctr\\u003e\\n \\u003cth align=\\\"left\\\" rowspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003eCase\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\" rowspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003eBone union\\u003c/p\\u003e\\n \\u003cp\\u003e(at 3 month)\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\" colspan=\\\"3\\\"\\u003e\\n \\u003cp\\u003eFunctional outcomes\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\" rowspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003eRadiographic oteoarthritis (Eaton-Littler classification)\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eOpposition (Kapandji score)\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eAbduction (degree)\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003ePinch and grip strength\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/thead\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e(+)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e10/10\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u0026gt;\\u0026thinsp;45\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e100\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e(-)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e(+)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e9/10\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e30\\u0026ndash;45\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e80\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eStage 1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e(+)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e10/10\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u0026gt;\\u0026thinsp;45\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e100\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e(-)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e(+)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e10/10\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u0026gt;\\u0026thinsp;45\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e100\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e(-)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e(+)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e10/10\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u0026gt;\\u0026thinsp;45\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e90\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e(-)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n \\u003c/table\\u003e\\n\\u003c/div\\u003e\\n\\u003cp\\u003e\\u003cbr\\u003e\\u003c/p\\u003e\\n\\u003cdiv class=\\\"Section2\\\" id=\\\"Sec5\\\"\\u003e\\n \\u003ch2\\u003eCASES PRESENTATION\\u003c/h2\\u003e\\n \\u003cdiv class=\\\"Section3\\\" id=\\\"Sec6\\\"\\u003e\\n \\u003ch2\\u003eCASE 1\\u003c/h2\\u003e\\n \\u003cp\\u003eA 26-year-old male patient (patient 3) was brought to the emergency department because of close, Rolando fracture over left hand due to contusion in a traffic accident (Fig. \\u003cspan class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e). He received open reduction internal fixation via dorsal approach with a hooked embracing plate 2 days after the injury. No peri-operative complications as infection or neurovascular damage was noted. The interval from operation to mobilization was 12 days. Radiologic reduction showed an excellent result after 20 days of surgery (Fig. 4). The left thumb achieved fine functional outcomes of range of motion after 5 weeks follow-up (Fig. 5).\\u003c/p\\u003e\\n \\u003c/div\\u003e\\n\\u003c/div\\u003e\\n\\u003cdiv class=\\\"Section2\\\" id=\\\"Sec7\\\"\\u003e\\n \\u003ch2\\u003eCASE 2\\u003c/h2\\u003e\\n \\u003cp\\u003eA 74-year-old female patient (patient 2) suffered from Rolando fracture over right hand due to a traffic accident (Fig. \\u003cspan class=\\\"InternalRef\\\"\\u003e6\\u003c/span\\u003e). She underwent open reduction internal fixation with a hooked embracing plate 3 days after the injury. There were no peri-operative complications nor neuromuscular damage after surgical intervention. The interval from operation to mobilization was 13 days. Radiologic reduction showed a good result after 17 days of surgery (Fig. \\u003cspan class=\\\"InternalRef\\\"\\u003e7\\u003c/span\\u003e). The opposition, fingers pinch, flexion and extension of right thumb were all good without disabilities after 4 months follow-up (Video 1).\\u003c/p\\u003e\\n\\u003c/div\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eConservative treatment with splinting or close reduction with percutaneous pinning seems to have poor reduction and functional outcomes in previous studies(\\u003cspan additionalcitationids=\\\"CR16\\\" citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e). For Rolando fracture with large segments, open reduction with internal fixation via either lag screw or mini-plate is preferable(\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eA hook embracing plate (Acumed, 1.3mm, Rolando Fracture Hooked Plate) was introduced for Rolando fracture but with few evidence. In our study, all our patients achieved excellent radiologic reduction, fine bone union, good hand function after surgery with a hook embracing plate. Comparing with lag screw or mini-plate according to previous studies(\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e), both the radiologic and functional results were non-inferior with earlier mobilization. No significant peri-operative complications including infection, neurovascular damage or loss of reduction were noted in our patients.\\u003c/p\\u003e \\u003cp\\u003eRestoration of articular surface is relative important(\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e). However, several studies did not found a strong relation between joint incongruity and osteoarthritis(\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e). Despite that, one of our patients with a post-operative joint incongruity around 1-2mm suffered from a mild radiographic osteoarthritis without significant disability. Therefore, anatomical reduction should be achieved as possible to prevent such post-operative sequelae.\\u003c/p\\u003e \\u003cp\\u003eIn our experience, the hook design allows an extra-bone-to-connective tissue support by positioned the hook on the ligamentous structure over the metacarpal base. The ligamentous structures around the TMC joint, especially the volar oblique ligament, play a big role in stabilization of the joint(\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e). The extra-support could help further stabilize the fixation and diminish the joint deformity. Besides, the hook design allows us to restore the articular surface easier, preventing excessive bone stripping or joint capsule destruction in order to achieve anatomical reduction. The periosteum and surrounding tissue could be persevered better, and it might be benefit on better circulation for bone union. Besides, the design of embracing arm portion of the plate, we thought the fixation might be more rigid from two dimensions of fixation screws.\\u003c/p\\u003e \\u003cp\\u003eOn the other hand, the price of the hook embracing plate was relative expensive than traditional lag screw or mini-plate, leading to the relative small case number in our studies. Moreover, the technique is demanding and needs high degree of precision.\\u003c/p\\u003e \\u003cp\\u003eThere were a few limitations in our study. First, it was a retrospective study of descriptive characteristic but no comparison with the results from other fixation methods or conservative treatment. Second, the included patient number was relatively small, and the follow-up time was relatively short. Furthermore, few studies had evaluation of the surgical outcomes for Rolando fractures, and most of these studies had a small patient number. Therefore, meaningful comparisons of the outcomes with other studies became much more difficult.\\u003c/p\\u003e \\u003cp\\u003eDespite of the limitations, we still found that the hooked embracing plate provides fine preliminary result in patients with Rolando fracture, even in elder people with possible risks of osteoporosis. This method may provide more confidence of surgical fixation for post-operative early mobilization which also may contribute the better results. Therefore, open reduction via hooked embracing plate shall be considered as a better solution for Rolando fracture. Meanwhile, we can also design prospective studies with more detail comparison for further follow-up.\\u003c/p\\u003e\"},{\"header\":\"Conclusion\",\"content\":\"\\u003cp\\u003eThe hooked embracing plate is a good and safe option for surgical fixation in patients with Rolando fracture. Compared with traditional method such as lag screw or mini-plate fixation, the hooked embracing plate could provide non-inferior radiologic and functional outcomes with fine bone union and earlier mobilization.\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eEthics approval and consent to participate\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe study was approved by the Chang Gung Medical Foundation Institutional\\u0026nbsp;Review Board\\u0026nbsp;(CGMF-IRB, No.202101329B0). All methods were carried out in accordance with relevant guidelines and regulations.\\u0026nbsp;Besides, according to Chang Gung Medical Foundation Institutional Review Board (CGMF-IRB), the informed consent for participate was waived because our study was a retrospective study analyzing the clinical outcomes of our patients based on medical records. The participants in our study had the lowest risk, and the risk of participants was no more than non-participants.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConsent for publication\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNot applicable.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAvailability of data and materials\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eAll data generated or analyzed during this study are included in this published article.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCompeting interests\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors declare that they have no competing interests.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFunding\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors declare that they have no funding.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAuthors\\u0026apos; contributions\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eYJ Tsai and JP Yeh wrote the main manuscript text. YJ Tsai, TH Lin and TS Lin provided patient data. All authors reviewed the manuscript.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAcknowledgements\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNot applicable.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\u003cli\\u003e\\u003cspan\\u003eRolando S. Fracture of the base of the first metacarpal and a variation that has not yet been described. 1910. Clin Orthop Relat Res. 1996(327):4\\u0026ndash;8.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eLanghoff O, Andersen K, Kjaer-Petersen K. Rolando's fracture. J Hand Surg Br. 1991;16(4):454\\u0026ndash;9.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eHong E. Hand injuries in sports medicine. Prim Care. 2005;32(1):91\\u0026ndash;103.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eSood A, Granick MS. Rolando fracture. Eplasty. 2014;14:ic16.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eMcCann MR, Rust PA, Wallace R. The Stabilising Effect of the Anterior Oblique Ligament to Prevent Directional Subluxation at the Trapeziometacarpal Joint of the Thumb: A Biomechanical Cadaveric Study. Arch Bone Jt Surg. 2018;6(2):105\\u0026ndash;11.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eBrown MT, Rust PA. Fractures of the thumb metacarpal base. Injury. 2020;51(11):2421\\u0026ndash;8.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eEaton RG, Lane LB, Littler JW, Keyser JJ. Ligament reconstruction for the painful thumb carpometacarpal joint: a long-term assessment. J Hand Surg Am. 1984;9(5):692\\u0026ndash;99.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eUludag S, Ataker Y, Seyahi A, Tetik O, Gudemez E. Early rehabilitation after stable osteosynthesis of intra-articular fractures of the metacarpal base of the thumb. J Hand Surg Eur Vol. 2015;40(4):370\\u0026ndash;3.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eMumtaz MU, Ahmad F, Kawoosa AA, Hussain I, Wani I. Treatment of Rolando Fractures by Open Reduction and Internal Fixation using Mini T-Plate and Screws. J Hand Microsurg. 2016;8(2):80\\u0026ndash;5.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eTeoh LC, Lee JY. Mallet fractures: a novel approach to internal fixation using a hook plate. J Hand Surg Eur Vol. 2007;32(1):24\\u0026ndash;30.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eKapandji A. [Clinical test of apposition and counter-apposition of the thumb]. Ann Chir Main. 1986;5(1):67\\u0026ndash;73.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eEaton RG, Glickel SZ. Trapeziometacarpal osteoarthritis. Staging as a rationale for treatment. Hand Clin. 1987;3(4):455\\u0026ndash;71.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eCantero J. [Bennett's fracture-luxation. Osteosynthesis by the dorsal approach]. Ann Chir Main. 1984;3(2):165\\u0026ndash;7.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eFoster RJ, Hastings H 2nd. Treatment of Bennett, Rolando, and vertical intraarticular trapezial fractures. Clin Orthop Relat Res. 1987(214):121\\u0026ndash;9.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eLiverneaux PA, Ichihara S, Hendriks S, Facca S, Bodin F. Fractures and dislocation of the base of the thumb metacarpal. J Hand Surg Eur Vol. 2015;40(1):42\\u0026ndash;50.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eVichard P, Tropet Y, Nicolet F. Longitudinal pinning of fractures of the base of the first metacarpal. Ann Chir Main. 1982;1(4):301\\u0026ndash;6.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003evan Niekerk JL, Ouwens R. Fractures of the base of the first metacarpal bone: results of surgical treatment. Injury. 1989;20(6):359\\u0026ndash;62.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eLecl\\u0026egrave;re FM, Jenzer A, H\\u0026uuml;sler R, Kiermeir D, Bignion D, Unglaub F, et al. 7-year follow-up after open reduction and internal screw fixation in Bennett fractures. Arch Orthop Trauma Surg. 2012;132(7):1045\\u0026ndash;51.\\u003c/span\\u003e\\u003c/li\\u003e\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":false,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":true,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-surgery\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"bsur\",\"sideBox\":\"Learn more about [BMC Surgery](http://bmcsurg.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"https://www.editorialmanager.com/bsur/default.aspx\",\"title\":\"BMC Surgery\",\"twitterHandle\":\"@BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Rolando fracture, thumb metacarpal base fracture, hooked embracing plate, hook plate\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-2172154/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-2172154/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003ch2\\u003eBackground\\u003c/h2\\u003e \\u003cp\\u003eRolando fracture is a comminuted, intra-articular fracture over the metacarpal bone base of the thumb which often leads to joint instability and requirement of surgery. The aim of this study is to evaluate the radiological and functional outcomes of Rolando fracture following surgical fixation with a hooked embracing plate designed for Rolando fracture.\\u003c/p\\u003e\\u003ch2\\u003eMethod\\u003c/h2\\u003e \\u003cp\\u003eWe retrospectively reviewed a consequence of patients between 2018 to 2022 with Rolando fracture who received open reduction internal fixation with hooked embracing plates. Primary endpoints were the quality of radiologic reduction after the operation and peri-operative complications. Secondary outcomes were bone union, pinch and grip strength, palmar abduction, opposition and radiographic osteoarthritis over the trapeziometacarpal (TMC) joint.\\u003c/p\\u003e\\u003ch2\\u003eResults\\u003c/h2\\u003e \\u003cp\\u003eA total of 5 patients were included. All patients had good quality of radiological reduction without peri-operative complications. The opposition, abduction, pinch and grip strength were nearly full-recovered for all patients with fine bone unions after 3 months follow-up.\\u003c/p\\u003e\\u003ch2\\u003eConclusion\\u003c/h2\\u003e \\u003cp\\u003eThe hooked embracing plate is a good and safe option for surgical fixation in patients with Rolando fracture. Compared with traditional method such as lag screw or mini-plate fixation, the hooked embracing plate could provide rigid fixation with fine radiologic and functional outcomes with early mobilization.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Hooked Embracing Plate for Rolando Fracture Fixation: A Preliminary Result\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2022-11-07 15:09:23\",\"doi\":\"10.21203/rs.3.rs-2172154/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0},{\"type\":\"decision\",\"content\":\"Major revision\",\"date\":\"2022-11-10T03:23:31+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2022-11-06T15:14:22+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"845760c9-aa78-4115-ada3-498208487963\",\"date\":\"2022-11-04T19:34:37+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewersInvited\",\"content\":\"\",\"date\":\"2022-11-04T17:41:01+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorAssigned\",\"content\":\"\",\"date\":\"2022-11-04T17:37:36+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvited\",\"content\":\"\",\"date\":\"2022-11-03T07:51:59+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"checksComplete\",\"content\":\"\",\"date\":\"2022-11-03T07:49:04+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"submitted\",\"content\":\"BMC Surgery\",\"date\":\"2022-10-16T16:49:54+00:00\",\"index\":\"\",\"fulltext\":\"\"}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-surgery\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"bsur\",\"sideBox\":\"Learn more about [BMC Surgery](http://bmcsurg.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"https://www.editorialmanager.com/bsur/default.aspx\",\"title\":\"BMC Surgery\",\"twitterHandle\":\"@BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"f2ac4a76-4d72-4bd7-a006-bd374c7d56bb\",\"owner\":[],\"postedDate\":\"November 7th, 2022\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"under-review\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2022-12-02T07:44:10+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2022-11-07 15:09:23\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-2172154\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-2172154\",\"identity\":\"rs-2172154\",\"version\":[\"v1\"]},\"buildId\":\"7rjqhiLT3MXkJMwkYKINL\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}