eMedicine Specialties > Orthopedic Surgery > Hand & Upper Extremity

Bennett Fracture: Treatment

Author: Steven V Priano, MD, Assistant Professor of Orthopedic Surgery, Department of Orthopedics and Sports Medicine, Ohio State University College of Medicine and Public Health
Coauthor(s): Mark E Baratz, MD, Professor, Department of Orthopaedics, Drexel University College of Medicine; Residency Director, Department of Orthopaedics, Allegheny General Hospital; Consulting Staff, Allegheny Orthopaedic Associates
Contributor Information and Disclosures

Updated: Jan 11, 2008

Treatment

Medical Therapy

Closed reduction and thumb spica cast immobilization are effective in the treatment of Bennett fractures if the reduction can be maintained. The closed reduction technique consists of thumb traction combined with metacarpal extension, pronation, and abduction. Direct downward pressure is applied to the dorsal radial metacarpal base. The strong pull of the APL frequently leads to displacement, necessitating open reduction and internal fixation or closed reduction with percutaneous pinning. More than 1 mm of articular incongruity or persistent CMC joint subluxation after closed reduction indicates the need for surgical treatment.2,3,5,7,8

Surgical Therapy

Generally, closed reduction utilizing the technique described above followed by percutaneous K-wire fixation is successful. Two 0.045-inch K-wires are drilled through the dorsal radial thumb metacarpal base into the reduced volar ulnar fragment. If the fragment is very small, reduction may be maintained by placing the K-wire from the thumb metacarpal into the trapezium or the index metacarpal. Maintaining thumb abduction is essential to preserving the first web space.

If adequate reduction cannot be achieved utilizing this percutaneous technique, open reduction and internal fixation is performed. An L-shaped incision is made over the subcutaneous border of the thumb metacarpal. The incision is carried down radially to allow for subperiosteal reflection of the thenar musculature and direct visualization of the joint. Towel-clip forceps are extremely valuable in obtaining and temporarily maintaining reduction. Fixation is achieved using either K-wires or mini screws (2.0 mm).2,3,5,7,8

Follow-up

A well-molded thumb spica cast is utilized for 2-6 weeks depending on the stability obtained at surgery. Once the cast is discontinued, a thermoplastic splint is fabricated and a protected mobilization program is initiated until fracture healing is complete.

Complications

Displaced intra-articular fractures predispose the patient to arthritis and loss of motion within the affected joints. Unfortunately, even after restoration of articular congruity, some patients develop posttraumatic arthritis secondary to the osteocartilaginous injury sustained as a result of the initial trauma.

Loss of motion also occurs following prolonged immobilization. Rigid fixation enables patients to initiate movement sooner postoperatively, minimizing this problem.

Other potential postoperative complications include loss of reduction with recurrent joint subluxation and instability, infection, and sensory nerve injury.

More on Bennett Fracture

Overview: Bennett Fracture
Workup: Bennett Fracture
Treatment: Bennett Fracture
Follow-up: Bennett Fracture
Multimedia: Bennett Fracture
References
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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. Nov-Dec 1999;7(6):403-12. [Medline].

  6. Nagaoka M, Nagao S, Matsuzaki H. Trapeziometacarpal joint instability after Bennett's fracture-dislocation. J Orthop Sci. Jul 2005;10(4):374-7. [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]. Apr 2003;28(2):142-7. [Medline].

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Further Reading

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Keywords

thumb CMC fractures, thumb carpal-metacarpal fracture, thumb carpometacarpal fracture, Bennett's fracture, Bennett's fractures, thumb injury, thumb fracture

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Contributor Information and Disclosures

Author

Steven V Priano, MD, Assistant Professor of Orthopedic Surgery, Department of Orthopedics and Sports Medicine, Ohio State University College of Medicine and Public Health
Steven V Priano, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons
Disclosure: Nothing to disclose.

Coauthor(s)

Mark E Baratz, MD, Professor, Department of Orthopaedics, Drexel University College of Medicine; Residency Director, Department of Orthopaedics, Allegheny General Hospital; Consulting Staff, Allegheny Orthopaedic Associates
Mark E Baratz, MD is a member of the following medical societies: Allegheny County Medical Society, American Academy of Orthopaedic Surgeons, American Association for Hand Surgery, American Orthopaedic Association, American Society for Surgery of the Hand, Orthopaedic Research Society, and Pennsylvania Orthopaedic Society
Disclosure: Nothing to disclose.

Medical Editor

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, American Academy of Pediatrics, American Association for Hand Surgery, American College of Surgeons, American Medical Association, Arthroscopy Association of North America, Clinical Orthopaedic Society, Mid-Central States Orthopaedic Society, and Missouri State Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Thomas R Hunt III, MD, John D Sherrill Professor and Director of Orthopaedic Surgery, Surgeon in Chief of UAB Highlands Hospital, Director of Hand and Upper Extremity Fellowship, University of Alabama at Birmingham
Thomas R Hunt III, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association for Hand Surgery, American Orthopaedic Association, American Orthopaedic Society for Sports Medicine, American Society for Surgery of the Hand, AO Foundation, Mid-America Orthopaedic Association, and Southern Orthopaedic Association
Disclosure: Tornier Consulting fee Review panel membership; Tornier Royalty None; Tornier Ownership interest None

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

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 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, and Arkansas Medical Society
Disclosure: Nothing to disclose.

 
 
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