9/12/2014

Bennett Fracture

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Bennett Fracture
Author: Mark E Baratz, MD; Chief Editor: Harris Gellman, MD more...
Updated: Aug 13, 2014

Background
In 1882, Edward Hallaran Bennett, MD, described the fracture of the base of the first metacarpal that bears his
name. Bennett described the anatomic details of the fracture and suggested that early diagnosis and treatment are
imperative to prevent loss of function of this highly mobile joint.[1, 2, 3, 4, 5]
Images depicting Bennett fracture are shown below.

Radiograph of a Bennett fracture.

Percutaneous pinning of a Bennett fracture.

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Bennett Fracture

Rolando fracture. This is differentiated from a Bennett fracture because of the presence of intra-articular comminution.

Problem
Unless properly recognized and treated, this intra-articular fracture subluxation may result in an unstable arthritic
joint with secondary loss of motion and pain. Because the thumb carpometacarpal (CMC) joint is critical for pinch
and opposition, this injury may severely affect function.

Epidemiology
Frequency
The thumb is a highly mobile border digit. For that reason, injury to this ray is common.

Etiology
Axial loading of a partially flexed thumb metacarpal causes this injury.[6]

Pathophysiology
Thumb CMC joint stability is maintained by 5 ligaments and the articular contours. The most critical of these
stabilizers is the volar oblique ligament. This ligament courses from the volar lip of the trapezium to the volar ulnar
corner of the thumb metacarpal base. The injury occurs when an axial force is transmitted through a partially flexed
thumb metacarpal. The portion of the metacarpal onto which the volar oblique ligament inserts remains in anatomic
position, and the remainder of the articular base subluxates in a dorsal, radial, and proximal direction because of the
pull of the abductor pollicis longus (APL).

Presentation
Patients present with swelling and pain at the thumb base. On examination, motion is limited and CMC instability is
frequently noted with gentle stress of the thumb metacarpal.

Indications
Closed reduction and thumb spica cast immobilization can be effective in the treatment of some Bennett fractures.
Generally, cases characterized by small avulsion fractures and minimal articular incongruity and instability can be
managed in this fashion. These patients must be carefully monitored with serial radiography. The strong pull of the
abductor pollicis longus (APL) frequently leads to displacement. As a result, open or closed reduction combined with
internal fixation is frequently required. More than 1 mm of articular incongruity after closed reduction is an indication
for operative intervention. This degree of articular incongruity is associated with an increased rate of articular
degeneration in the thumb CMC joint over time.[2, 3, 5, 7, 8]

Relevant Anatomy
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The thumb affords prehensile abilities that were essential in human evolution. The bony anatomy of the thumb
consists of 2 phalanges and a metacarpal, which articulates with the trapezium bone in the distal carpal row. The
metacarpal is actually a primordial phalanx.
The CMC joint consists of an articulation between the trapezium and the metacarpal base composed of 2
reciprocally interlocking saddles with perpendicular longitudinal axes. Ligamentous stability at the trapeziometacarpal
joint is maintained by the anterior (volar) and posterior oblique ligaments, the anterior and posterior intermetacarpal
ligaments, and the dorsal radial ligament. The anterior (volar) oblique ligament originates on the trapezium and
inserts into the volar ulnar beak of the thumb metacarpal. This is the most important ligament in maintaining CMC
stability. The dorsal ligament is not as strong as the volar ligament but is reinforced by the APL.

Contraindications
Contraindications to closed treatment include an open fracture, an unstable fracture, unsuccessful closed reduction
with residual articular incongruity greater than 1 mm, or instability and joint subluxation.

Contributor Information and Disclosures

Author
Mark E Baratz, MD Professor, Department of Orthopaedics, Drexel University College of Medicine; Residency
Director, Department of Orthopaedics, Allegheny General Hospital; Consulting Staff, Allegheny Orthopaedic
Associates
Mark E Baratz, MD is a member of the following medical societies: Allegheny County Medical Society, American
Academy of Orthopaedic Surgeons, American Association for Hand Surgery, American Orthopaedic Association,
American Society for Surgery of the Hand, Orthopaedic Research Society, and Pennsylvania Orthopaedic Society
Disclosure: Integra Life Sciences Royalty None; Integra Life Sciences Consulting fee Speaking and teaching;
Integra Life Sciences Grant/research funds None; Elizur Consulting fee Consulting
Specialty Editor Board
Michael S Clarke, MD Clinical Associate Professor, Department of Orthopedic Surgery, University of MissouriColumbia School of Medicine
Michael S Clarke, MD is a member of the following medical societies: American Academy of Orthopaedic
Surgeons, American Academy of Pediatrics, American Association for Hand Surgery, American College of
Surgeons, American Medical Association, Arthroscopy Association of North America, Clinical Orthopaedic
Society, Mid-Central States Orthopaedic Society, and Missouri State Medical Association
Disclosure: Nothing to disclose.
Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College
of Pharmacy; Editor-in-Chief, Medscape Drug Reference
Disclosure: Medscape Salary Employment
Thomas R Hunt III, MD Professor and Chairman, Joseph Barnhart Department of Orthopedic Surgery, Baylor
College of Medicine
Thomas R Hunt III, MD is a member of the following medical societies: American Academy of Orthopaedic
Surgeons, American Association for Hand Surgery, American Orthopaedic Association, American Orthopaedic
Society for Sports Medicine, American Society for Surgery of the Hand, AO Foundation, Mid-America Orthopaedic
Association, and Southern Orthopaedic Association
Disclosure: Tornier Royalty Independent contractor; Tornier Ownership interest None; Lippincott Royalty
Independent contractor
Dinesh Patel, MD, FACS Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of
Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic
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Surgeons
Disclosure: Nothing to disclose.
Chief Editor
Harris Gellman, MD Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic
Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami, Leonard M
Miller School of Medicine, Clinical Professor, Surgery, Nova Southeastern School of Medicine
Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture,
American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery
of the Hand, and Arkansas Medical Society
Disclosure: Nothing to disclose.
Additional Contributors
The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author
Steven V Priano, MD, to the original writing and development of this article.

References
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New York, NY. Churchill Livingstone;1999:711-772.
3. Peimer CA, Wolfe SW, Elliot AJ. Metacarpal and carpometacarpal trauma. In: Surgery of the Hand and
Upper Extremity. 1st ed. New York, NY. McGraw-Hill;1996:883-920.
4. Rockwood CA, Green DP, Butler TE Jr. Fractures and dislocations of the hand. In: Rockwood and Green's
Fractures in Adults. Philadelphia, Pa. Lippincott-Raven;1996:607-744.
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wire fixation versus open reduction internal fixation in the treatment of Bennett's fracture dislocation. J Hand
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percutaneous fixation of simulated Bennett's fracture. J Hand Surg Am. Apr 2009;34(4):637-41. [Medline].
12. Davis TR, Pace A. Trapeziectomy for trapeziometacarpal joint osteoarthritis: is ligament reconstruction and
temporary stabilisation of the pseudarthrosis with a Kirschner wire important?. J Hand Surg Eur Vol. Jun
2009;34(3):312-21. [Medline].
13. Giannikas D, Karabasi A, Fotinopoulos E, Tyllianakis M. Open transtrapezial injuries of the thumb: operative
treatment. J Trauma. Dec 2008;65(6):1468-70. [Medline].
14. Leclre FM, Jenzer A, Hsler R, Kiermeir D, Bignion D, Unglaub F, et al. 7-year follow-up after open
reduction and internal screw fixation in Bennett fractures. Arch Orthop Trauma Surg. Jul 2012;132(7):1045http://emedicine.medscape.com/article/1238036-overview#a04

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wiring. J Hand Surg Am. Mar 2012;37(3):427-33. [Medline].
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Laborers by Tension Fixation. J Hand Surg Am. Aug 5 2014;[Medline].
Medscape Reference 2011 WebMD, LLC

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