Case: 184

Bennett's Fracture

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History: 25 yo male s/p hand injury
Solution: Bennett's fracture is a fracture of the base of the first metacarpal that extends into the carpometacarpal (CMC) joint. It was first described by Dr. Edward Hallaran Bennett in 1882. He correctly suggested that early diagnosis and treatment are imperative to prevent loss of function because unless properly recognized and treated, this intra-articular fracture-subluxation can result in an unstable joint that is prone to early osteoarthritis with loss of motion and pain. Closed reduction and thumb spica cast immobilization can be effective in the treatment of some Bennett fractures, but because of the strong pull of the abductor pollicis longus (APL) there is frequently displacement of the fracture fragment with this treatment and as a result, open or closed reduction combined with internal fixation is often required. Management is based upon degree of displacement with < 1mm being managed with external reduction and casting with serial follow up radiographs, 1-3 mm displacement (like this case) being managed with external reduction and pinning, and > 3 mm displacement requiring ORIF.

Radiograph Images

Questions

The most appropriate management for the most important injury is:
  • Closed reduction and casting
  • Closed reduction and pinning
  • Open reduction and casting
  • Open reduction and pinning
This injury has only recently been recognized as signficant.
False
What is the acronym for the most clinically relevant this injury?
Bennett's fracture