Open reduction and internal fixation versus closed reduction and percutaneous fixation in the treatment of Bennett fractures: A systematic review

Greeven, Alexander P A; Groningen, J. Van; Schep, N.W.L.; Lieshout, Esther M.M. Van; Verhofstad, M.H.J.

doi:10.1016/j.injury.2019.06.027

Cited by 12 publications

(9 citation statements)

References 30 publications

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“…Although historical reports have noted satisfactory outcomes with nonsurgical treatment, more recent studies have shown poor outcomes with casting alone for this injury [12][13][14][15]. Surgical treatment includes closed reduction with percutaneous pinning or open reduction with either pins or inter fragmentary fixation [16]. With the development of arthroscopy, some doctors prefer arthroscopic reduction and internal fixation [17,18].…”

Section: Discussionmentioning

confidence: 99%

Accuracy of fluoroscopic examination in the treatment of Bennett’s fracture

Yin

Wang

et al. 2021

BMC Musculoskelet Disord

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Background Restoration of joint congruity is an important factor for the prevention of subsequent arthritis in patients with Bennett’s fracture. Surgical treatment of Bennett’s fracture is thus generally recommended for displaced intra-articular fractures to the proximal aspect of the thumb metacarpal. Fluoroscopic examination is used to evaluate the adequacy of closed reduction after pinning of Bennett’s fracture. The purpose of this study was to determine the accuracy of fluoroscopy to determine the reduction of Bennett’s fractures. Methods A model was created, to mimic a Bennett’s fracture utilizing ten fresh-frozen cadaveric hands. An oblique cut was made in the proximal aspect of the thumb metacarpal using an oscillating saw. The small oblique fragment involved 1/4–1/3 of the joint surface was then shifted in position creating a step-off or gap at the fracture site. An anatomical reduction model, gap models (1 mm, 2 mm, 3 mm), and step-off models (1 mm, 2 mm, 3 mm) were created using percutaneous fixation with two 1.0 mm Kirschner wires for each cadaveric hand. Fluoroscopic assessment then took place and was reviewed by 2 attending hand surgeons blinded to the actual position. Their estimated fluoroscopic position was then compared to the actual displacement. Results The step-off and gap on fluoroscopic examination showed a significant difference compared to the step-off and gap from direct visualization. The frequency of underestimation for the 3 mm displacement models from the fluoroscopic examination was 60%. The frequency for overestimated was 9% for the models in which displacement was within 2 mm (0, 1, 2 mm). Conclusions The assessment of articular gap and step-off using PA (postero-anterior), AP (antero-posterior), and lateral view of fluoroscopic examination is not accurate as compared to the examination by direct visualization. Surgeons need to be aware that PA, AP and lateral view of fluoroscopic examination alone may not be sufficient to judge the final position of a reduced Bennett’s fracture. Other methods such as live fluoroscopy in multiple different planes, 3-dimensional fluoroscopy or arthroscopic examination should be considered.

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Section: Discussionmentioning

confidence: 99%

Accuracy of fluoroscopic examination in the treatment of Bennett’s fracture

Yin

Wang

et al. 2021

BMC Musculoskelet Disord

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“…Similarly we also noted that there is a less number of patients with post traumatic arthritis in the T2MC group as compared to TTZ group, which again concluded that T2MC is a better fixation method in preventing post traumatic arthritis of the first CMC joint. In a systematic review conducted by Greevan et al, noted that posttraumatic arthrosis as scored using the Eaton Littler score was more common in patients treated with ORIF than in patients treated with CRIF [12].…”

Section: Discussionmentioning

confidence: 99%

Comparison of Functional Outcome Between Trans– 2nd Metacarpal Fixation and Trans-Trapezius Fixation with K-Wire for Bennett Fracture

Navale¹,

Gulati²

2021

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Introduction: An articular fracture of the base of the thumb metacarpal consisting of a single, variable-sized, volar-ulnar fracture fragment is termed Bennett fracture. In the studies conducted so far there has been paucity in the knowledge about the methods of k wire fixation for the Bennett fracture and hence the purpose of this study is to compare functional outcome between the trans – 2nd metacarpal fixation and trans – trapezius fixation with K wire for Bennett fracture. Methods: Patients were 18 years and above with no previous injury on the 1st metacarpal . Final assessment was performed from six months to nine months after the treatment with the DASH Score, VAS scale for pain, Hand Grip strength by Dynamometer. Radiographic images were taken at 6 months post-op in two separate views to evaluate post-traumatic arthritis of the first CMC joint. Results: Statistical analysis showed a correlation between Pain and DASH score to be 0.946 in TTZ group and 0.966 in T2MC group and hence signifies that patients in T2MC group had a better functional outcome with lower DASH score and lower pain score. Significant correlation was seen between Pain and Grip strength, with -0.587 in TTZ group and -0.482 in T2MC group. Higher pain score correlated with higher DASH score and lower Grip strength and hence we can conclude that T2MC had a better functional outcome post-surgery than TTZ technique of fixation. Post op radiographs showed that T2MC group of patients had a better outcome with less arthritic complications and less pain and better grip strength. Conclusion: This study gives us the overview about the two fixation methods of Bennett fracture , and that when trans 2nd metacarpal fixation is done , there are less chances of arthritis of the CMC joint as well as better functional outcomes post operatively as compared to trans trapezial fixation and hence guides a surgeon to make a decision about the technique of fixation to be employed during fixing such fracture. Keywords: Bennett fracture, Trans-trapezial, Trans- 2nd metacarpal, Functional outcome

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“…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).…”

Section: Developmentmentioning

confidence: 99%

Bennett Fracture

García¹,

Pesántez²,

Méndez³

et al. 2023

EPRA

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Introduction: The intra-articular fracture separating the palmar ulnar aspect of the base of the first metacarpal from the rest of the first metacarpal is called Bennetts fracture. Injuries are usually caused by axial loads on the partially flexed metacarpal bones. Radiographs are needed to evaluate these injuries and to schedule surgery to relieve them, since such fractures are assumed to be unstable. Surgical treatment of these fractures alters depending on the extent of the injury. It may include closed reduction with percutaneous fixation or open reduction with fixation or interfragmentary fixation. With good fracture localization and fixation, the postoperative outcome is usually good. Objective: to detail the current information related to Bennetts fracture, presentation, evaluation, comparison with Rolandos fracture, in addition to the diagnosis and treatment of the disease. Methodology: a total of 28 articles were analyzed in this review, including review and original articles, as well as clinical cases, of which 18 bibliographies were used because the other articles were not relevant to this study. The sources of information were PubMed, Google Scholar and Cochrane; the terms used to search for information in Spanish, Portuguese and English were: Bennett fracture. Bennetts, fratura da base do primer metacarpiano. Results: Anteroposterior, lateral and oblique projections are common when taking radiographs of the hand, however Roberts view can reveal more details about the injury. Both Bennetts and Rolandos fractures present the same pathogenic mechanism however the damaging force is of greater magnitude than in Bennets fractures. K-wire fixation is better than plate and/or screw osteosynthesis as a treatment because of the benefit of keeping costs down without harming the patient in the long term. Direct visualization is the most accurate method to assess joint separation and articular pitch, PA, AP and lateral projections on fluoroscopic examination may not be sufficient to determine the final position of a reduced Bennett fracture. Conclusions: Although there is no consensus on which treatment is best, surgical treatment of Bennett fractures is usually used because closed reduction and cast immobilization without internal fixation are often unstable due to deforming forces. Indications for surgical treatment for fractures of the base of the first metacarpal include extra-articular fractures with more than 30 degrees of angulation after reduction; loss of reduction after non-operative treatment; and intra-articular fractures: displaced Bennett fractures greater than 1 mm or any Rolando fracture.The arthroscopically assisted screw fixation of Bennett reported fewer complications, shorter immobilization time and shorter tourniquet time. Keywords: fracture, Bennett, metacarpal, first.

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Open reduction and internal fixation versus closed reduction and percutaneous fixation in the treatment of Bennett fractures: A systematic review

Cited by 12 publications

References 30 publications

Accuracy of fluoroscopic examination in the treatment of Bennett’s fracture

Accuracy of fluoroscopic examination in the treatment of Bennett’s fracture

Comparison of Functional Outcome Between Trans– 2nd Metacarpal Fixation and Trans-Trapezius Fixation with K-Wire for Bennett Fracture

Bennett Fracture

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