Bennett/Rolando Fractures

35 yo male transferred for Ortho care s/p Motorcycle Accident.  Documented distal radius fracture.

 Distal radius is plenty comminuted...

...conspicuously intraarticular...

...with continued mild displacement after reduction. 

But unfortunately, this Bennett Fracture-Dislocation and questionable scapholunate widening weren't mentioned in the OSH sign off or in the dictation. 

Bennett Fracture-  fracture of the base of the thumb resulting from forced abduction of the first metacarpal. It is defined as an intra-articular two-part fracture of the base of the first metacarpal bone.

https://radiopaedia.org/articles/bennett-fracture?lang=us

vs.

Rolando Fracture- three-part or comminuted intra-articular fracture-dislocation of the base of the thumb (proximal first metacarpal). It can be thought of as a comminuted Bennett fracture.

https://radiopaedia.org/articles/rolando-fracture?lang=us

We're all someone else's OSH, so I'm not here to put their competence or ability on blast.  We all make mistakes (at least until Skynet is fully incorporated). 

It is a wonderful representation of "Satisfaction of Search" though.  It's easy to see that they were focused on the primary bone explosion, which fully explained the patient's symptoms, and walked away confident of their "W" without much further review. In redundant tasks, our brain craves ease and simplicity.

If I have any recommendations from this case, develop and deploy a search pattern for all of your MSK films and once you've honed it, Don't Deviate! (at least until that moment something else needs to be added).

This is probably the best representation of how I like to tackle a wrist.   

My dictation specifically mentions the distal radius and ulna, carpus, and partially visualized hand in an attempt to keep me honest to my plan.   I like to narrate my journey. 
 

Learning Points:

• The 1st metacarpal base can break like the best of them.  Bennett (2-part and 2 syllable) Fracture and Rolando (comminuted and more than 2 syllables) Fractures are worth knowing for the test and life.
• Think about search patterns and feel free to ask your staff how they like to tackle their studies.
• Every study is a battle against Satisfaction of Search.  Do your best!