Diagnostic Approach and Treatment of Intra-Articular Fractures at the Base of the First Metacarpal

Initial Diagnostic Approach

The American College of Radiology recommends CT without IV contrast to confirm the fracture and evaluate intra-articular extension and displacement in patients with suspected intra-articular first metacarpal base fractures 1
CT is particularly useful for carpometacarpal joint fracture dislocations that are difficult to recognize on plain radiographs, especially in patients with high clinical suspicion of intra-articular fracture 2
Three-dimensional reconstructions can be helpful in preoperative planning for complex articular injuries in patients with intra-articular fractures at the base of the first metacarpal 1
Standard thumb radiographs, including 2 views (PA and lateral) and an optional oblique projection, can be used to evaluate patients with suspected intra-articular first metacarpal base fractures, with the oblique projection slightly increasing diagnostic yield 1

Early active motion exercises should be initiated as soon as stability allows to prevent stiffness in patients who have undergone surgical treatment for intra-articular fractures at the base of the first metacarpal 3
Radiographic follow-up at approximately 3 weeks and at the time of hardware removal can be used to confirm adequate healing in patients who have undergone surgical treatment for intra-articular fractures at the base of the first metacarpal 4

Do not rely solely on plain radiographs when they are equivocal—obtain CT to avoid missed diagnosis in patients with suspected intra-articular first metacarpal base fractures 2, 1
Avoid conservative management with simple splinting for displaced intra-articular fractures, as this leads to poor outcomes in patients with intra-articular fractures at the base of the first metacarpal 3
Avoid excessive immobilization, which increases stiffness risk in patients who have undergone surgical treatment for intra-articular fractures at the base of the first metacarpal 3