Siora Surgicals

Learn about Injury to The First Metacarpal Bone

FRACTURE DISLOCATION OF THE FIRST METACARPAL BONE (BENNET’S FRACTURE)

MECHANISM OF INJURY

This type of injury usually happens in the young adults during sports and athletic activities. A fall on the thumb transmits the force along the first metacarpal bone.

NATURE OF INJURY

A small triangular-shaped piece of bone from the medial side of the base of the metacarpal bone gets detached. The piece maintains the normal relationship with the carpal bone whereas the main mass of the metacarpal is displaced laterally.

TREATMENT

Reduction by closed technique may be possible, but maintenance of the reduced position in plaster is always a difficult problem. The position must be checked repeatedly and may require repeated reductions. Imperfect reduction leads to osteo-arthritis of the first carpometacarpal-joint. Open reduction is preferable to closed reduction. Open reduction needs ortho implants and orthopedic instruments. These can be obtained from orthopedic implant distributors.

TECHNIQUES OF REDUCTION

A. Closed Reduction: This is obtained by applying traction after grasping the thumb. Pressure on the lateral aspect of the base of the metacarpal bone is exerted by the surgeon’s thumb. This shifts the metacarpal bone medially and brings it in apposition with the fractured segment.

Immobilization: Immobilization is done by applying a scaphoid type of plaster. The thumb should be placed in an abduction and the metacarpophalangeal joint in a slightly flexed position.

Frequent check x-ray examination are done. The plaster is removed after a period of 6 weeks.

B. Operative reduction: Open reduction is done by inserting Kirschner wire between the fractured segments.

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