Medical Imaging Analysis Report

I. Imaging Findings

Based on the provided X-ray images of the hand:

• A clear fracture line is visible at the base of the first metacarpal bone, partially involving the joint, extending to the proximal articular surface.
• The distal fragment shows a certain degree of displacement or subluxation relative to the proximal articular surface (shift toward the radial side, proximal direction, and dorsal tilt).
• The small palmar fragment at the base of the metacarpal (attached to the joint capsule or ligaments) remains relatively stable in position.
• No obvious significant swelling in the surrounding soft tissues, and no noticeable injury to other phalanges or carpal bones is apparent.

II. Possible Diagnoses

Taking into account the patient’s injury history (falling onto an outstretched hand), imaging findings, and local symptoms, the following diagnoses are considered:

1. Bennett’s Fracture
   Rationale: This type of fracture involves the intra-articular region at the base of the first metacarpal, commonly resulting from axial force or impact. The imaging typically reveals a wedge-shaped fragment at the base of the metacarpal with some displacement.
2. Rolando Fracture
   Rationale: Also occurs at the base of the first metacarpal, but typically presents as a T- or Y-shaped comminuted fracture. Since there is no apparent comminution on the images, the likelihood is slightly lower than Bennett’s fracture.
3. Simple Subluxation of the Thumb Carpometacarpal Joint
   Rationale: If there were no clear fracture line or intra-articular fragments, a pure dislocation could be considered. However, since this case shows a fracture line at the base, subluxation alone is not the sole diagnosis.

III. Final Diagnosis

Considering the imaging characteristics, mechanism of injury, and the typical pattern of a fracture at the base of the first metacarpal, the most consistent diagnosis is:

Bennett’s Fracture (intra-articular fracture of the first metacarpal base)

IV. Treatment Plan and Rehabilitation

1. Treatment Strategies

• Conservative Treatment: For minimally displaced fractures where articular alignment is acceptable, one may consider immobilizing the thumb in radial abduction (functional position) using a cast or splint for about 6 weeks. However, conservative treatment may lead to decreased range of motion at the carpometacarpal joint and reduced grip strength.
• Surgical Treatment:
  1. Closed Reduction & Percutaneous Kirschner Wire Fixation: Suitable for acute fractures with significant displacement that can still be reduced anatomically by external manipulation.
  2. Open Reduction & Internal Fixation: Indicated for older fractures or those unreducible by closed means, or cases with marked joint subluxation/malalignment.
  The key goal of surgery is to restore the anatomical alignment between the first metacarpal base and the carpometacarpal joint surface, minimizing post-traumatic arthritis and instability caused by articular incongruence.

2. Rehabilitation / Exercise Prescription

Once the fracture has healed and joint stability is ensured, gradual functional training should be undertaken to restore thumb mobility and overall hand grip strength. Following a staged, individualized approach, we recommend:

1. During Immobilization (initial 6 weeks):
   • Maintain the cast or splint to protect the thumb from stress.
   • Perform gentle movements with the unaffected fingers and wrist to reduce muscle atrophy and joint stiffness.
2. Early Stage After Cast/Splint Removal (6–8 weeks):
   • Under guidance from a physician or therapist, begin gentle passive and active exercises for the thumb joints, including flexion/extension, abduction/adduction, and opposition.
   • Perform 2–3 sessions per day, 5–10 minutes per session, ensuring no significant pain.
3. Later Strengthening Phase (8–12 weeks):
   • As joint range of motion improves, gradually add grip and pinch strengthening exercises, such as squeezing a soft ball or light resistance training with a band.
   • Increase exercise frequency to 3–4 sessions per day, 10–15 minutes each, based on patient tolerance.
   • Reduce intensity and frequency if notable pain or swelling arises.
4. Functional Recovery Phase (after 12 weeks):
   • Start normal daily activities such as lifting objects, typing, writing, and light sports.
   • Focus on improving hand coordination and dexterity, encouraging thumb use in regular gripping tasks.

If the patient has relatively poor bone quality or additional cardiopulmonary conditions, it is essential to follow the guidance of specialized physicians and rehabilitation therapists, closely monitoring exercise tolerance to ensure safe and effective training.

Disclaimer: This report is based on the currently provided medical history and imaging information and is intended for reference only. It does not substitute for in-person consultation or professional clinical advice. If necessary, please seek medical care or additional evaluations promptly.