Bennett fracture

Description

Bennett fracture: Intra-articular two-part fracture of the base of the first metacarpal with carpometacarpal joint involvement. Thumb fracture usually sustained with forced abduction of the first metacarpal.

Thumb metacarpal fractures are rare because of the thumb’s inherent mobility. However, when fractures do occur they usually involve the base — and the Bennett fracture is the most common type.

The Bennett fracture usually results from axial loading onto a partially flex thumb metacarpal. This can occur when a fist strikes a solid object.

The ulna portion of the base of the thumb remains in place, whereas the larger radial fragment is radially subluxed or dislocated by the pull of the abductor pollicus longus (APL) muscle. The ulna portion is stabilised by the deep ulnar ligament from the ulna and the anterior oblique ligament from the trapezium.

NOTE: Comminuted three-part T- or Y- shaped base of first metacarpal fractures are known eponymously as Rolando fracture, first described by Silvio Rolando in 1910


Imaging

  • Routine views of the thumb adequately define the nature of the fragment(s).
  • CT scans may be performed as part of the definitive management work-up.
Bennett Fracture thumb XR
Bennett fracture

Management

Treatment goals are to achieve articular congruity and stability of the thumb carpo-metacarpal joint.

Initial management

  • RICE
  • thumb spica splint

Definitive management options

  • closed reduction alone is unlikely to be successful as CMC stability is compromised by the pull of APL
  • closed reduction with percutaneous pinning (most common)
  • open reduction and internal fixation (this is also the usual treatment of a Rolando fracture, although external fixation may be performed depending on the size of the fragments).

History

1881 – Bennett presented to a meeting of the Pathological Society of Dublin Nov 12th 1881 the fracture-dislocation now eponymous with him. He published his treatise on fractures of the base of the first metacarpal in the Dublin Journal of Medical Science. [1882;73:72-75]

1886 – Bennett published further ‘On Fracture of the Metacarpal Bone of the Thumb‘ [1886;2(1331):12-13]

1897 – Bennett presented at the surgical section of the Royal Academy of Medicine. He produced anatomic specimens, photographs, casts of hands, and roentgenograms to demonstrate. Bennett presented nine anatomic specimens related to first metacarpal fractures. Five of these specimens showed the following lesion:

The fracture passed obliquely across the base of the bone, detaching the greater part of the articular surface and the piece of bone that was resting on this surface was projected toward the palm of the hand. The separated fragment was very large, and the deformity that resulted therefrom seemed more a dorsal subluxation of the first metacarpal.

Following the presentation and discussion ‘Sir William Stokes expressed the wish that the injury might in the future be associated with the name of Professor Bennett.‘ – Br Med J 1897;1:1479

Transcript of 1897 Presentation to the Royal Academy of Medicine in Ireland


Associated Persons


Alternative names

  • Bennett’s fracture
  • Bennett fracture luxation
  • Bennett fracture-dislocation
  • Intra-articular two-part fracture of the base of the first metacarpal

References


eponymictionary CTA

eponymictionary

the names behind the name

Emergency physician MA (Oxon) MBChB (Edin) FACEM FFSEM with a passion for rugby; medical history; medical education; and informatics. Asynchronous learning #FOAMed evangelist. Co-founder and CTO of Life in the Fast lane | Eponyms | Books | vocortex |

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