Management of Neglected Bennett Fracture in Manual Laborers by Tension Fixation

Abstract

Purpose To report the results of open reduction and internal fixation of Bennett fractures in young, active patients using a K-wire and wire-loop construct to achieve anatomical reduction and to allow return to manual labor. Methods In this prospective series, we treated 10 male manual laborers (mean age 30, range 20–44 ys) with Bennett fractures diagnosed after a minimum of 12 weeks (mean 16, range 12–18 ws). Open reduction with internal fixation using 2 K-wires with a wire loop and a neutralizing transarticular K-wire was performed with direct articular visualization. Patients were evaluated for range of motion, grip strength, and pinch strength, and a visual analog scale (VAS) score rated pain preoperatively and 12 months later. Results The mean follow-up was 16 months (12–36 ms). The average VAS improved from 6 to 2, mean palmar abduction improved from 15° to 40°, mean radial abduction increased from 22° to 39°, average pinch strength improved from 9.9 kg to 15.5 kg, and average grip strength increased from 34 kg to 49 kg. Complications included transient irritation of the radial sensory nerve or lateral cutaneous nerve of the forearm in 3 patients, pin track granuloma formation in 2 patients, and marginal osteophyte formation in 2 patients. Union was achieved in all 10 patients, and 9 patients returned to their previous manual labor occupation. Conclusion Our results suggest that neglected Bennett fractures can be effectively managed by open reduction and internal fixation using K-wires and a wire loop without compromising strength or motion. This technique reliably restored the anatomy and provided adequate thumb motion and strength to allow a return to manual labor. Type of study/level of evidence Therapeutic IV.

Bennett’s Fracture Management: A Systematic Review of Literature

“…In the prospective study of Mahmoud et al [ 22 ] that included 10 patients with surgical intervention, pain score improved along with function. Middleton et al [ 23 ] had the largest number of patients (143 patients).…”

Die Korrekturosteotomie an der Basis des ersten Mittelhandknochens nach in Fehlstellung konsolidierter Fraktur

“…Alle Osteotomien heilten aus, und 9 der 10 Patienten nahmen ihre alte berufliche Tätigkeit wieder auf. Leider machten die Autoren keine Angaben zum erreichten Ausgleich von Stufen und Spaltbildungen der Gelenkflächen 12 .…”