We are in the first week of training camp and already have three reports of thumb fracture on the injury wire. Ravens QB Robert Griffin III, Patriots WR Julian Edelman and Giants WR Sterling Shepard all have reported thumb fractures. Details are fairly light but thankfully all are considered to be non-surgical. With this trio of fractures, thought it was a good prompt to review some of the classic thumb fractures.
Here is a look at the typical thumb on x-ray. Notice, the sesamoid, a round structure off of the metacarpal head which is frequently confused for a fracture.
Oblique Proximal Phalanx Fracture
Injury: Jammed finger or direct trauma
Tx: Thumb Spica brace or Splint 4-6 weeks
RTP: Would consider play with protection or injury to non-dominant hand
Sx: Consider surgery if displaced or step-off greater at articular surface
1st Metatarsal Fracture
Injury: Direct impact to top of thumb
Tx: Thumb Spica brace or Splint 6-8 weeks
RTP: Would consider play with protection or injury to non-dominant hand, position dependent
Sx: Consider surgery if angulation greater than 30 degrees
Injury: Significant trauma to directly thumb in flexed position
Tx: Typically surgery is needed. Note metatarsal is partially dislocated
RTP: Would not allow return to play until full healed. High risk for arthritis
Sx: If non-displaced can consider non-operative treatment, but very unstable.
Injury: Thumb forced outward from the hand.
Tx: Minimally displaced treated with thumb spica cast
RTP: Would consider return with hard cast, position dependent.
Sx: Usually associated with ligament injury, if bony fragment acceptable usually same for ligament.
Injury: Crush injury or Stepped on
Tx: Typically treated with simple finger splint
RTP: Return based on pain and function
Sx: Usually associated with significant soft tissue injury to nail bed, watch for infection.