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Bennett Fracture

  • Author: Mark E Baratz, MD; Chief Editor: Harris Gellman, MD  more...
 
Updated: Jun 06, 2016
 

Background

In 1882, Edward Hallaran Bennett, MD, described the fracture of the base of the first metacarpal that bears his name. Bennett described the anatomic details of the fracture and suggested that early diagnosis and treatment are imperative to prevent loss of function of this highly mobile joint.[1, 2, 3, 4, 5]

Unless properly recognized and treated, this intra-articular fracture subluxation may result in an unstable arthritic joint with secondary loss of motion and pain. Because the thumb carpometacarpal (CMC) joint is critical for pinch and opposition, this injury may severely affect function.

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Anatomy

The thumb affords prehensile abilities that were essential in human evolution. The bony anatomy of the thumb consists of two phalanges and a metacarpal, which articulates with the trapezium bone in the distal carpal row. The metacarpal is actually a primordial phalanx.

The CMC joint consists of an articulation between the trapezium and the metacarpal base composed of two reciprocally interlocking saddles with perpendicular longitudinal axes. Ligamentous stability at the trapeziometacarpal joint is maintained by the anterior (volar) and posterior oblique ligaments, the anterior and posterior intermetacarpal ligaments, and the dorsal radial ligament.

The anterior (volar) oblique ligament originates on the trapezium and inserts into the volar ulnar beak of the thumb metacarpal. This is the most important ligament in maintaining CMC stability. The dorsal ligament is not as strong as the volar ligament but is reinforced by the APL.

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Pathophysiology and Etiology

The thumb is a highly mobile border digit. For that reason, injury to this ray is common. Thumb CMC joint stability is maintained by five ligaments and the articular contours. The most critical of these stabilizers is the volar oblique ligament. This ligament courses from the volar lip of the trapezium to the volar ulnar corner of the thumb metacarpal base.

A Bennett fracture occurs when an axial force is transmitted through a partially flexed thumb metacarpal.[6] The portion of the metacarpal onto which the volar oblique ligament inserts remains in anatomic position, and the remainder of the articular base subluxates in a dorsal, radial, and proximal direction because of the pull of the abductor pollicis longus (APL).

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Prognosis

The prognosis for Bennett fractures is most closely related to the amount of energy associated with the original injury. High-energy injuries produce comminution, articular surface damage, and extensive soft-tissue injury, leading to a poor outcome. With anatomic restoration of the joint surface and reestablishment of stability, the outcome is routinely good, especially in low-energy injuries with simple fracture patterns and limited soft-tissue involvement.

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Contributor Information and Disclosures
Author

Mark E Baratz, MD Orthopedic Specialists of UPMC

Mark E Baratz, MD is a member of the following medical societies: Orthopaedic Research Society, Pennsylvania Orthopaedic Society, Allegheny County Medical Society, American Academy of Orthopaedic Surgeons, American Association for Hand Surgery, American Orthopaedic Association, American Society for Surgery of the Hand

Disclosure: Received royalty from Integra Life Sciences for none; Received consulting fee from Integra Life Sciences for speaking and teaching; Received grant/research funds from Integra Life Sciences for none; Received consulting fee from Elizur for consulting.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Thomas R Hunt III, MD Professor and Chairman, Joseph Barnhart Department of Orthopedic Surgery, Baylor College of Medicine

Thomas R Hunt III, MD is a member of the following medical societies: American Orthopaedic Association, American Orthopaedic Society for Sports Medicine, Southern Orthopaedic Association, AO Foundation, American Academy of Orthopaedic Surgeons, American Association for Hand Surgery, American Society for Surgery of the Hand, Mid-America Orthopaedic Association

Disclosure: Received royalty from Tornier for independent contractor; Received ownership interest from Tornier for none; Received royalty from Lippincott for independent contractor.

Chief Editor

Harris Gellman, MD Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami, Leonard M Miller School of Medicine, Clinical Professor, Surgery, Nova Southeastern School of Medicine

Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery of the Hand, Arkansas Medical Society

Disclosure: Nothing to disclose.

Additional Contributors

Michael S Clarke, MD Clinical Associate Professor, Department of Orthopedic Surgery, University of Missouri-Columbia School of Medicine

Michael S Clarke, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Arthroscopy Association of North America, American Academy of Pediatrics, American Association for Hand Surgery, American College of Surgeons, American Medical Association, Clinical Orthopaedic Society, Mid-Central States Orthopaedic Society, Missouri State Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author Steven V Priano, MD, to the original writing and development of this article.

References
  1. Bennett EH. Fractures of the Metacarpal Bones. Dublin Med Sci J. 1882. 73:72-75.

  2. Green DP, Stern PJ. Fractures of the metacarpals and phalanges. In: Green's Operative Hand Surgery. New York, NY. Churchill Livingstone. 1999:711-772.

  3. Peimer CA, Wolfe SW, Elliot AJ. Metacarpal and carpometacarpal trauma. In: Surgery of the Hand and Upper Extremity. 1st ed. New York, NY. McGraw-Hill. 1996:883-920.

  4. Rockwood CA, Green DP, Butler TE Jr. Fractures and dislocations of the hand. In: Rockwood and Green's Fractures in Adults. Philadelphia, Pa. Lippincott-Raven. 1996:607-744.

  5. Soyer AD. Fractures of the base of the first metacarpal: current treatment options. J Am Acad Orthop Surg. 1999 Nov-Dec. 7(6):403-12. [Medline].

  6. Carlsen BT, Moran SL. Thumb trauma: Bennett fractures, Rolando fractures, and ulnar collateral ligament injuries. J Hand Surg Am. 2009 May-Jun. 34(5):945-52. [Medline].

  7. Sawaizumi T, Nanno M, Nanbu A, Ito H. Percutaneous leverage pinning in the treatment of Bennett's fracture. J Orthop Sci. 2005. 10(1):27-31. [Medline].

  8. Lutz M, Sailer R, Zimmermann R, Gabl M, Ulmer H, Pechlaner S. Closed reduction transarticular Kirschner wire fixation versus open reduction internal fixation in the treatment of Bennett's fracture dislocation. J Hand Surg [Br]. 2003 Apr. 28(2):142-7. [Medline].

  9. Capo JT, Kinchelow T, Orillaza NS, Rossy W. Accuracy of fluoroscopy in closed reduction and percutaneous fixation of simulated Bennett's fracture. J Hand Surg Am. 2009 Apr. 34(4):637-41. [Medline].

  10. Nagaoka M, Nagao S, Matsuzaki H. Trapeziometacarpal joint instability after Bennett's fracture-dislocation. J Orthop Sci. 2005 Jul. 10(4):374-7. [Medline].

  11. Brownlie C, Anderson D. Bennett fracture dislocation - review and management. Aust Fam Physician. 2011 Jun. 40(6):394-6. [Medline].

  12. Davis TR, Pace A. Trapeziectomy for trapeziometacarpal joint osteoarthritis: is ligament reconstruction and temporary stabilisation of the pseudarthrosis with a Kirschner wire important?. J Hand Surg Eur Vol. 2009 Jun. 34(3):312-21. [Medline].

  13. Giannikas D, Karabasi A, Fotinopoulos E, Tyllianakis M. Open transtrapezial injuries of the thumb: operative treatment. J Trauma. 2008 Dec. 65(6):1468-70. [Medline].

  14. Leclère FM, Jenzer A, Hüsler R, Kiermeir D, Bignion D, Unglaub F, et al. 7-year follow-up after open reduction and internal screw fixation in Bennett fractures. Arch Orthop Trauma Surg. 2012 Jul. 132(7):1045-51. [Medline].

  15. Zhang X, Shao X, Zhang Z, Wen S, Sun J, Wang B. Treatment of a Bennett fracture using tension band wiring. J Hand Surg Am. 2012 Mar. 37(3):427-33. [Medline].

  16. Mahmoud M, El Shafie S, Menorca RM, Elfar JC. Management of Neglected Bennett Fracture in Manual Laborers by Tension Fixation. J Hand Surg Am. 2014 Aug 5. [Medline].

  17. Zemirline A, Lebailly F, Taleb C, Facca S, Liverneaux P. Arthroscopic assisted percutaneous screw fixation of Bennett's fracture. Hand Surg. 2014. 19 (2):281-6. [Medline].

  18. Pomares G, Strugarek-Lecoanet C, Dap F, Dautel G. Bennett fracture: Arthroscopically assisted percutaneous screw fixation versus open surgery: Functional and radiological outcomes. Orthop Traumatol Surg Res. 2016 May. 102 (3):357-61. [Medline].

 
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Radiograph of a Bennett fracture.
Percutaneous pinning of a Bennett fracture.
Rolando fracture. This is differentiated from a Bennett fracture because of the presence of intra-articular comminution.
 
 
 
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