Bennett's Fracture Research Articles

A long-term study following bennett's fracture

Twenty-five patients with documented Bennett's Fractures were reviewed five to sixteen years following injury (Mean 9.6 years). The majority of fractures affected the dominant hand and occurred in males. Twenty-two patients were managed conservatively by plaster immobilisation. At review ten patients were asymptomatic and only two had significant symptoms. Examination revealed loss of movement in the trapeziometacarpal joint of the thumb in twenty-one cases. Five of these exhibited malrotation of the thumb. Review of the post reduction radiographs revealed separation of the fragments by 1 mm or more in sixteen patients, but symptoms at follow-up could not be correlated with accuracy of reduction. Twenty-three patients had a varus angulation of the first metacarpal base which could be correlated to the initial post-reduction displacement. There was no correlation with the restriction of movement. Although metacarpal length will only be maintained by reduction of the fracture, there was little evidence that imperfect reduction leads to significant symptomatic arthritis in the long term.

Closed rupture of flexor pollicis longus tendon associated with treatment of Bennett's fracture

Closed rupture of flexor pollicis longus tendon associated with treatment of Bennett's fracture

Closed rupture of flexor pollicis longus tendon associated with treatment of Bennett's fracture

A case of closed rupture of the tendon of flexor pollicis longus following treatment of a Bennett's fracture is described. This unusual complication was treated by transfer of the tendon of flexor digitorum superficialis of the ring finger.

Place de l'ostéosynthèse par vissage simple ou par mini-plaque vissée dans les fractures de la base du premier métacarpien: A propos de trente-neuf observations

Re-establishing normal osteoarticular anatomy, and early mobilization are the principal elements in the successful treatment of fractures of the base of the first metacarpal. To achieve these goals in thirty-nine fractures rigid fixation was obtained by screw alone, or by a mini-plate. Seven Bennett's fractures have been treated by screw fixation when the size of the fragment has made it possible. Extra-articular fractures have been treated, either by screw alone, in oblique fractures (7 cases). Or by mini-plate, T or L shaped, in transverse fractures (23 cases). The use of these techniques have been extended, to comminuted fractures but is not used in Bennett's fractures when the fragment is too small to allow the screw to be anchored in it without its being shattered.

Place de l'embrochage longitudinal dans les fractures de la base du premier métacarpien

From an experience of 120 fractures of the base of the first metacarpal bone, the authors evaluated the functional results of in 40 patients followed-up. Most of these patients had been treated by Bunden's method of longitudinal pinning. If one eliminates the comminuted fractures and the Bennett's fractures with a single large fragment treated by screw fixation the method of longitudinal pinning restores normal function to the first interdigitalspace Furthermore, the development of secondary arthrosis of the trapezo-metacarpal joint is rare.

THE IMPORTANCE OF SOFT TISSUES IN CERTAIN SKELETAL TRAUMATIC LESIONS

Soft tissue aspects of skeletal trauma are discussed according to two categories: (1) those injuries in which the significance of the soft tissue in the pathophysiology of the skeletal lesion is indicated by the characteristics of the skeletal injury (such as extension teardrop fracture, little leaguer's elbow, "baseball fracture," and Bennett's fracture); and (2) those injuries in which the associated soft tissue injury, or complication, may be reasonably inferred by the location and nature of the skeletal injury (such as major facial fractures, posterior sternoclavicular dislocations, fractures of the lower rib and lumbar transverse processes, and pelvic disruptions).

Fractures at the base of the thumb

Oblique traction on the thumb metacarpal, originally described for the treatment of Bennett's fracture, has been applied to comminuted intra-articular fractures of the thumb metacarpal to counter the forces that cause shortening and varus angulation. It also has been applied to fractures of the trapezium to restore congruity of the trapeziometacarpal joint. It was successful in achieving and maintaining a satisfactory reduction in eight patients with these three types of fractures.

Fractures of the phalanges and metacarpals: An analysis of 555 fractures

A retrospective analysis of 555 finger ray fractures in 525 patients treated at the University of Virginia Medical Center showed that most fractures were “successfully” (prompt union and good-to-excellent function) treated by closed reduction and splinting. The most common injuries were the Boxer's fracture and tuft fractures of the long and ring fingers. Both of these injuries can be treated simply with immobilization after adequate care of the soft tissue wounds. Fractures in which early referral to a hand surgeon is indicated include: 1) Impacted fractures of the proximal portion of the proximal phalanges with volar angulation. 2) Intaarticular fractures involving more than 25% of the joint surface. 3) Fracture dislocation of the PIP joint. 4) All “chip” fractures around joints associated with ligamentous instability. 5) Bennett's fracture — dislocation of the proximal thumb joint. 6) Compound fractures of phalanges and metacarpals (exclusive of tuft fractures). 7) Simple fractures in which closed reduction is attempted but unsuccessful. 8) Fractures which dislocate after initial treatment despite attempted immobilization.

Compression-fusion of the first carpometacarpal joint (rizarthrodesis) in the treatment of disability arising from neglected Bennett's fracture: a new surgical technique

A new method of trapeziometacarpal fusion is described. Its essential features are compression using a new device, rigid internal fixation with an AO small-fragment T-plate with or without cancellous bone grafting, no postoperative external fixation and early active movements.

Compression fixation of Bennett's fracture.

A procedure that ensures exact reduction and internal fixation of Bennett's fracture is presented. In cases with a large tubercular fragment, the internal fixation is performed with a lag-screw technique. If the fragment is small, a Kirschner wire is used as an implant. A special set of instruments that keeps the reduced fragment in position and guides the implant during the internal fixation process is also described.

Screw fixation for certain fractures of the phalanges and metacarpals

Twenty-one patients with fractures of the bones of the hand were treated by open reduction and internal fixation with compression screws. The firm fixation allowed range-of-motion exercises in most patients to be begun on the third postoperative day. On follow-up mild restriction in digital motion was seen in only one patient, and significant disturbance in joint function was not encountered. In spite of these advantages, the method is indicated in only a small percentage of such fractures. Usually traditional methods of open reduction and internal fixation are preferred when an open procedure is needed. However, oblique and spiral fractures of the proximal phalanx, some fractures with large single articular fragments particularly involving the proximal interphalangeal joint, and appropriate Bennett's fractures are suitable for screw fixation.

Bennett's fracture

A new method of conservative treatment of Bennett's fracture is presented, the thumb being immobilised in moderate adduction rather than radial abduction. Anatomical dissections are outlined to demonstrate the rationale of this procedure.

Bennett's fracture

Summary Bennett's fracture deserves consideration as an entity because failure to recognise the difficulty in maintaining the reduction invariably leads to pain and disability. This fracture-dislocation of the carpo-metacarpal joint of the thumb frequently occurs from a blow with a clenched fist and is easy to reduce with longitudinal traction and direct pressure. The fracture occurs most often in the dominant hand of males. Many methods of treatment have been used since recognition of the entity by Bennett in 1882 but percutaneous pinning after accurate closed reduction is most satisfactory. Complications of percutaneous pinning are few and the method has the advantage that reduction is better maintained and joint stiffness from traction methods is avoided. Prognosis is excellent with this method of treatment.

A study of Bennett's fracture. Special reference to fixation by percutaneous pinning.

In the present study radiological evaluation of 45 cases of Bennett's fracture reveals that different types of fracture dislocations correlate with late and typical deformities of the metacarpal joint surface. Functional results with special reference to treatment by closed reduction and percutaneous pinning show that this method was successful in most cases treated (92%). It is concluded that percutaneous pinning offers a simple and reliable way of fixation which eliminates the need for X-rays during the healing period. Untoward effects on the joints caused by the pins were not observed and the incidence of secondary arthrosis was not higher than reported for other methods of internal fixation.

Arthroplasty in Traumatic Arthritis of the Joints of the Hand

Two types of traumatic disability in joints of the hand treated by implant resection arthroplasty have been presented. A trapezium resection procedure utilizing a heat molded intramedullary stemmed implant for trapeziometacarpal joint arthroplasty has been used. The results have been very satisfactory in 38 patients, including four patients with post-traumatic arthritis following an old Bennett fracture. Proximal interphalangeal joint implant resection arthroplasty has been used in severe traumatic disabilities of the proximal interphalangeal joint associated with joint disorganization. Lateral instability has not been a complaint. A useful, pain-free range of motion has been achieved without significant complications. It is felt that these arthroplasty techniques can be useful adjuncts to reconstructive surgery of the hand.

Fractures Involving the Digits of the Hand

Summary Trauma involving the digits frequently results in fractures and dislocations. If severe or if improperly treated, they may result in instability, stiffness, pain, and loss of normal function. Certain principles of treatment have been outlined. Unstable fractures must be secured by proper immobilization. Guarded early motion should receive high priority. The frequently difficult to treat Bennett fracture of the basal joint of the thumb and the fracture dislocation of the proximal inter-phalangeal joint of the finger are discussed. Methods permitting precise reduction and fixation and early movement are suggested to discourage the frequent sequelae of degenerative arthritis.

THE CONSERVATIVE TREATMENT OF BENNETT'S FRACTURE-SUBLUXATION OF THE THUMB METACARPAL

1. The treatment of Bennett's fracture is reviewed and the relative merits of conservative and operative treatment is considered. 2. A closed method of treatment is described and a series of thirty-one patients so treated is analysed. There were twenty-nine successful results. 3. It is urged that conservative treatment is the method of choice, and that operative measures should be reserved for the occasion when closed methods have failed.

Bennett's Fracture in Childhood

Bennett's Fracture in Childhood

BENNETT'S FRACTURE

A method of treatment of Bennett's fracture is described. A Kirschner wire is drilled obliquely through the base of the first metacarpal bone and traction is applied in a distal, ulnar and palmar direction in order to counteract the dislocating action of abductor pollicis longus and the flexor muscles. The advantages of the method are: 1) It is technically easy and practically without complications. No important structures are liable to be damaged. 2) It can be used in those cases where the palmar fragment is very small. 3) It can be used for comminuted fractures. 4) It can be used in neglected cases where malunion has occurred. 5) It can be used when there are other fractures of the first metacarpal or adjacent bones. 6) It allows exercises of all the finger joints during the whole period of treatment.

Bennett's fracture in general practice.

A review of eight cases of Bennett's fracture is presented. The mechanism of injury appears well defined and a simple method of treatment is described. Uniformly good results have been achieved in all eight cases.