Comparative study of Iselin’s technique for the treatment of Bennett’s fracture with large and small fragments

Abstract

Objective: The thumb is very exposed to trauma due to its position and function. Fractures of the base of the first metacarpal bone are very frequent in hand traumatology. Most Bennett’s fractures are treated surgically. However, the optimal surgical approach is controversial. The aim of this study is to compare the results of closed reduction and percutaneous pinning in the treatment of Bennett’s fracture of the base of firsthand metacarpal in fractures with both small and large fragments. Methods: We studied retrospectively the data of 40 patients treated for a Bennett’s fracture in the department of orthopaedic and traumatologic surgery between January 2016 and December 2018. The purpose of this study was to compare the functional (pain, grip strength, first web space opening and thumb opposition) and radiological (quality of reduction and arthritic changes) results of the Iselin’s technique for the treatment of Bennett’s fractures in two groups of patients with large and small bone fragments according to the size of articular surface detached with the antero-medial fragment (superior or inferior to 25%). Results: The average age of the patients was 34 (range = 19–66) years. Males were by far the most affected (90%). We noted 24 cases of large fragment fractures (60%) and 16 cases of small fragment fracture (40%). An excellent overall functional result was found in 68.8% of cases of small fragment fractures versus 50% of cases of large fragment fractures. Radiological results were roughly similar. Conclusion: All surgical techniques aim to restore the articular congruence to the best, maintain the opening of the first web space and obtain a stable and painless trapezo-metacarpal joint. The Iselin’s technique is simple, inexpensive and easy to perform even by inexperienced surgeons. It yields satisfactory results in most cases of Bennett’s fracture regardless of the size of the fragment.

The Current Concept and Evidence-Based Practice in the Base of the First Metacarpal Bone Fracture

“…The posterior approach (Cantero technique) and the palmar approach (Gedda-Moberg technique) are two possible surgical techniques for ORIF. Pins can be used for steps performed through the skin, but opening up the fractured area allows for the use of more durable techniques such as plates [ 30 , 31 ] and screws, which can be either conventional [ 12 , 31 ] or cannulated compression screws [ 36 ].…”

Bennett Fracture

“…ORIF has typically been recommended the instant the fracture fragment is more than 25% of the articular surface and when the joint line cannot be reduced to less than 2 mm of displacement with closed reduction. Closed reduction and percutaneous fixation generate adequate clinical results, although complications such as pintract infections and secondary dislocation have been reported (4,13).…”

Peri-articular fractures of the hand

“…Multiple papers have described various techniques of stabilization and report variable outcomes. Classically, open reduction internal fixation (ORIF) has been recommended when the fracture fragment is greater than 25% of the articular surface, and when the joint surface cannot be reduced to less than 2 mm displacement by closed means (Bouaicha et al, 2022). However, Greeven et al (2019) performed a systematic review on 10 retrospective studies that either performed ORIF (n ¼ 138) or closed reduction internal fixation (CRIF) (n ¼ 77).…”