Thumb Trauma: Bennett Fractures, Rolando Fractures, and Ulnar Collateral Ligament Injuries

Carlsen, Brian T.; Moran, Steven L.

doi:10.1016/j.jhsa.2009.03.017

Cited by 91 publications

(58 citation statements)

References 42 publications

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“…As shown in the numerous articles published, the intraarticular fracture of the base of the first metacarpal is still a therapeutic challenge for hand surgeons [2,14]. In his original article, Bennett [1] described treating two patients with a 4-week cast immobilization.…”

Section: Discussionmentioning

confidence: 99%

“…Surgical treatment is varied and includes closed reduction with percutaneous pinning or open reduction with either pins or interfragmentary fixation. The literature has shown that good clinical results, independent of the operative procedure employed, can be observed, if successful reduction of the fracture was achieved and maintained [2]. Culp and Johnson [10] advocate the assistance of endoscopy to best reduce the fracture.…”

Section: Discussionmentioning

confidence: 99%

“…Although described as early as in 1882 by Bennett [1], the intra-articular fracture of the base of the first metacarpal remains a therapeutic challenge for hand surgeons [2]. Its prevalence accounts for around one-third of all fractures of the first metacarpal in adults [3], predominates in adult males and usually occurs in the dominant hand [4].…”

Section: Introductionmentioning

confidence: 99%

“…When a fracture occurs, the fragment remains attached to this strong ligament, whereas the pull of the APL tendon, extensor pollicis brevis and longus tendons dislocate the remainder of the metacarpal dorsally, radially and proximally [5,6]. Many treatments have been described for the treatment of Bennett fractures, including closed reduction with percutaneous pinning, open reduction with either pins or interfragmentary fixation, oblique traction pinning and external fixation [2,[7][8][9]. Recently, Culp and Johnson [10] also described an arthroscopically assisted percutaneous fixation of these fractures.…”

Section: Introductionmentioning

confidence: 99%

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7-year follow-up after open reduction and internal screw fixation in Bennett fractures

Leclère

Jenzer

Hüsler

et al. 2012

Arch Orthop Trauma Surg

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Background Bennett fractures are unstable, and, with inadequate treatment, lead to osteoarthritis, weakness and loss of function of the first carpometacarpal joint. This study focuses on long-term functional and radiological outcomes after open reduction and internal fixation. Methods Between June 1997 and December 2005, 24 patients with Bennett fractures were treated with open reduction and internal fixation with screws at our center. Radiological and functional assessments including range of motion of the thumb and pinch and grip strength were performed 4 months post-procedure and at the long-term follow-up, on average 83 months after surgery. Results Reduction of the Bennett fracture was maintained as it was at the time of the procedure in 96 % of the cases when fixation with two lag screws was performed. At the 4-month follow-up, mean pinch and grip strength reached 92 ± 3 and 89 ± 4 % of the contralateral side, respectively. Long-term follow-up demonstrated no correlation between the accuracy of the fracture reduction and the development of post-traumatic arthritis. Conclusion Good clinical results could be observed, if successful reduction of the fracture was achieved and maintained. However, there was no correlation between the accuracy of the fracture reduction considering a gap and step \2 mm and the development of arthritis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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7-year follow-up after open reduction and internal screw fixation in Bennett fractures

Leclère

Jenzer

Hüsler

et al. 2012

Arch Orthop Trauma Surg

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“…The resulting malunion and consequent arthritis of the trapeziometacarpal joint can cause pain, limit motion, and compromise function. Manual laborers are particularly susceptible to disability with this condition (1). We have had the opportunity to treat a number of late presenting or neglected Bennett fractures, which resulted from improper diagnosis, poor choice of management, or limited resources in the setting of a major metropolitan center in the developing world.…”

Section: Introductionmentioning

confidence: 99%

Management of Neglected Bennett Fracture in Manual Laborers by Tension Fixation

Mahmoud

Shafie

Menorca

et al. 2014

The Journal of Hand Surgery

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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.

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