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radiograph imaging can be difficult to interpret and at times will require CT scan
to fully characterize the injury. Minimally or nondisplaced fractures are generally
managed with a splint or cast. Displaced fractures often require closed reduction,
possible pinning, and subsequent casting. Carpometacarpal dislocations alone or
in conjunction with a base fracture are unstable and often require operative
stabilization ( Fig. 109.14 ). Bennett fractures, or intra-articular fractures of the
base of the thumb metacarpal, mandate special attention, as the thumb
carpometacarpal joint is critical for full use of this digit ( Fig. 109.15 ). Similarly,
Rolando fractures, comminuted fractures of the base of the thumb metacarpal,
also require careful attention. These fractures can be addressed temporarily with a
thumb spica splint and timely referral.

CARPALS
CLINICAL PEARLS AND PITFALLS
The scaphoid is the most commonly fractured carpal bone.
Ligamentous injuries and dislocations can be subtle but have
significant morbidity.