Bennetts Fracture

INTRODUCTION:

This is an oblique fracture of the base of the first (thumb) metacarpal with associated subluxation and fracture of the carpometacarpal articular surfaces. It is the commonest fracture to affect the thumb and is a serious injury; failure to treat it quickly and appropriately can lead to much disability through disruption of the pinching and opposition functions of the thumb.

MECHANISM OF INJURY:

Bennett’s fracture usually occurs due to an axial blow on a partially flexed first metacarpal, such as would occur during delivery of a punch with a clenched fist.1

SYMPTOMS:

There is acute, severe pain and swelling at the base of the thumb.

Grossly reduced movement at the 1st carpometacarpal joint.

Instability at the carpometacarpal joint may be noted with gentle stressing of the thumb metacarpal.

DIAGNOSIS:

Take true AP and lateral views to fully appreciate the presence of fracture and degree of displacement.

There is a classical oblique fracture line at the base of the first metacarpal with a triangular fragment at the ulnar base of the metacarpal.

The distal metacarpal portion will be displaced to a variable degree. Highly displaced fractures, those with significant crushing or impaction at the carpometacarpal joint, and those with shearing or impaction injury to radial side of articular surface of the trapezium carry a worse prognosis and are inevitably going to need operative intervention.

MANAGEMENT:

  • Fractures with <1–2 mm of disruption of articular congruity and minimal displacement may be treated by closed reduction and, if the reduction is maintained, placement in a thumb spica cast for 6 weeks or so.
  • Reduction is achieved through longitudinal traction on the thumb with metacarpal extension, pronation and abduction.
  • However, most cases will require surgical intervention, either through closed reduction and percutaneous placement of K-wires, or open reduction and internal fixation using K-wires and/or screws.
  • After operative intervention, splinting in a thumb spica cast for 2–6 weeks is necessary, depending on the degree of stability obtained during surgery.

Subsequent immobilisation in a thermoplastic splint is used to allow gradual mobilisation until healing is complete.

COMPLICATIONS:

  • Osteoarthritis
  • Persistent pain
  • Loss of grip
  • Radial nerve injury

PHYSIOLINE’S SPECIALISED PHYSIOTHERAPY HAS VITAL ROLE TO PLAY

At Physioline, all the members of the rehabilitation team work together so as to provide proper care and the therapy in order to:

  • Relief pain
  • Reduce stiffness
  • Strengthening of muscles
  • Prevention of complications

 

Visit Physioline for the Consultation and treatment.