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synonyms:thumb metacarpal fracture, Bennett fracture, Bennett's fracture
Bennett's Fracture ICD-10
Bennett's Fracture ICD-9
- 815.01(closed fracture base of thumb metacarpal)
- 815.11(open fracture base of thumb metacarpal)
- 815.00 (closed metacarpal fracture; unspecified)
Bennett's Fracture CPT Codes
Bennett's Fracture Etiology / Epidemiology / Natural History
- Intra-articular avulsion fracture of the volar-oblique ligament of the the thumb CMC joint.
Bennett's Fracture Anatomy
- Abductor pollicis longus and adductor pollicis displace the metacarpal radially and proximally.
- Anterior oblique ligament remains attached to the volar-ulnar fragment
- Bennett fragment is the volar-ulnar aspect of the metacarpal base.
Bennett's Fracture Clinical Evaluation
- Pain, swelling, ecchymosis at the thumb MC base.
- Document neurovascular exam.
Bennett's Fracture Xray / Diagnositc Tests
- P/A, lateral and oblique views of the thumb.
- True lateral view: palmar surface of the hand is placed flat on cassette; hand and wrist are pronated 15°-35° . Tube directed obliquely 15°distal-to-proximal, centered over the trapeziometacarpal joint (Billing L, Acta Radiol1952; 38:471).
Bennett's Fracture Classification / Treatment
- Bennett fragment < 20% of the articular surface: CRPP. Drill K-wire obliquely across the thumb the trapeziometacarpal joint while the the fracture is reduced by extending and pronating the metacarpal while longitudinal traction and downward pressure are applied to the metacarpal base.
- Bennett fragment>20% of the articular surface:ORIF. Wagner incision between the abductor pollicis longus and the thenar muscles, extended proximally and radially to the radial border of the flexor carpi radialis. Reflect thenar muscles subperiosteally, incise joint capsule. Debride hematoma from Fracture site. Reduce Fracture. Fix with 2.0- or 2.7-mm lag screw.
- see also AO Foundation(link is external).
- >1mm malunion=arthritis. Consider conservative care for fractures with <2mm displacement, or patients with underlying advance arthritis.
Bennett's Fracture Associated Injuries / Differential Diagnosis
- Gamekeepers thumb
- Rolando fracture
Bennett's Fracture Complications
- Infection
- Malunion
- Arthritis
- Stiffness / Contracture
- Nonunion
- Pain
- Painful hardware
Bennett's Fracture Follow-up Care
- Post-op: Thumb spica splint, elevation, NWB
- 7-10 Days: Wound check, Thumb spica cast
- 6 Weeks: K-wire removal, begin ROM exercises provided union is evident on xray.
- 3 Months: Evaluated ROM. Sport specific rehab.
- 6 Months:
- 1Yr: f/u xrays, Assess outcome.
Bennett's Fracture Review References
- Rivlin M, Fei W, Mudgal CS. Bennett Fracture. J Hand Surg Am. 2015 Aug;40(8):1667-8. doi: 10.1016/j.jhsa.2015.05.017. Epub 2015 Jul 3.
- Carlsen BT, Moran SL. Thumb trauma: Bennett fractures, Rolando fractures, and ulnar collateral ligament injuries. J Hand Surg Am. 2009 May-Jun;34(5):945-52.
- Soyer AD. Fractures of the base of the first metacarpal: current treatment options. J Am Acad Orthop Surg. 1999 Nov-Dec;7(6):403-12.
- Howard, CORR 220:46;1987
- Rockwood, Green, and Wilkins' Fractures in Adults(link is external)
- Green's Operative Hand Surgery, 2-Volume Set, 7e(link is external)
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