Bennett’s Fracture Repair—Which Method Results in the Best Functional Outcome? A Retrospective Cohort Analysis and Systematic Literature Review of Patient-Reported Functional Outcomes

Abstract

Surgical fixation of Bennett’s fracture of the thumb is critical to prevent functional impairment; however, there is no consensus on the optimal fixation method. We performed an 11-year retrospective cohort analysis and a systematic literature review to determine long-term patient-reported outcomes following Bennett’s fracture fixation. Retrospective cohort analysis identified 49 patients treated with Kirschner (K)-wire fixation, 85% returned to unrestricted movement during hand therapy. Forty-seven patients (96%) completed the disabilities of the arm, shoulder, and hand (DASH) questionnaires at a mean of 5.55 years from injury, with a mean score of 7.75. Systematic literature review identified 14 studies with a cumulative 541 patients. Fixation included open or percutaneous methods utilizing K-wires, tension band wiring, lag screws, T-Plates, external fixation, and arthroscopic screw fixation. Functional outcomes reported included DASH, quickDASH (qDASH), and visual analogue scores. Superficial wound infection occurred in 4 to 8% of percutaneous K-wire fixation. Open reduction internal fixation (ORIF) methods were associated with a 4 to 20% rate of reintervention and 5 to 28% rate of persistent paresthesia. Closed reduction with percutaneous K-wire fixation should be the first choice surgical method, given excellent, long-term functional outcomes, and low risk of complications. ORIF should be utilized where closed reduction is not achievable; however, the current evidence does not support one method of ORIF above another.

Keywords

Bennett’s fracture - hand surgery - K-wire - functional outcome - long-term

• References

• 1 Bennett EH. Fractures of the metacarpal bones. Dublin J Med Sci 1882; 73: 72-75
• 2 Pellegrini Jr VD, Olcott CW, Hollenberg G. Contact patterns in the trapeziometacarpal joint: the role of the palmar beak ligament. J Hand Surg Am 1993; 18 (02) 238-244
• 3 Griffiths JC. Fractures at the base of the first metacarpal bone. J Bone Joint Surg Br 1964; 46: 712-719
• 4 Gedda KO. Studies on Bennett’s fracture; anatomy, roentgenology, and therapy. Acta Chir Scand Suppl 1954; 193: 1-114
• 5 Rivlin M, Fei W, Mudgal CS. Bennett fracture. J Hand Surg Am 2015; 40 (08) 1667-1668
• 6 Moher D, Shamseer L, Clarke M. et al. PRISMA-P Group. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev 2015; 4 (01) 1
• 7 Kapandji A. [Clinical test of apposition and counter-apposition of the thumb] (French). Ann Chir Main 1986; 5 (01) 67-73
• 8 Livesley PJ. The conservative management of Bennett’s fracture-dislocation: a 26-year follow-up. J Hand Surg [Br] 1990; 15 (03) 291-294
• 9 Gedda KO, Moberg E. Open reduction and osteosynthesis of the so-called Bennett’s fracture in the carpo-metacarpal joint of the thumb. Acta Orthop Scand 1952; 22 (1-4) 249-257
• 10 Franchignoni F, Vercelli S, Giordano A, Sartorio F, Bravini E, Ferriero G. Minimal clinically important difference of the disabilities of the arm, shoulder and hand outcome measure (DASH) and its shortened version (QuickDASH). J Orthop Sports Phys Ther 2014; 44 (01) 30-39
• 11 Li Z, Guo Y, Tian W, Tian G. Closed reduction external fixator fixation versus open reduction internal fixation in the patients with Bennett fracture dislocation. Chin Med J (Engl) 2014; 127 (22) 3902-3905
• 12 Levy V, Mazzola M, Gonzalez M. Intra-articular fracture of the base of the first metacarpal bone: treatment through a volar approach. Hand (N Y) 2018; 13 (01) 90-94
• 13 Brüske J, Bednarski M, Niedźwiedź Z, Zyluk A, Grzeszewski S. The results of operative treatment of fractures of the thumb metacarpal base. Acta Orthop Belg 2001; 67 (04) 368-373
• 14 van JLM Niekerk, Ouwens R. Fractures of the base of the first metacarpal bone: results of surgical treatment. Injury 1989; 20 (06) 359-362
• 15 Sälgeback S, Eiken O, Carstam N, Ohlsson NM. A study of Bennett’s fracture. Special reference to fixation by percutaneous pinning. Scand J Plast Reconstr Surg 1971; 5 (02) 142-148
• 16 Zhang X, Shao X, Zhang Z, Wen S, Sun J, Wang B. Treatment of a Bennett fracture using tension band wiring. J Hand Surg Am 2012; 37 (03) 427-433
• 17 Zhang X, Dhawan V, Zhao S, Yu Y, Shao X, Zhang G. Treatment of Bennett fractures with tension-band wiring through a small incision under loupes and a headlight. Phys Sportsmed 2019; 47 (01) 122-128
• 18 Kamphuis SJM, Greeven AP, Kleinveld S, Gosens T, Van Lieshout EMM, Verhofstad MHJ. Bennett’s fracture: Comparative study between open and closed surgical techniques. Hand Surg Rehabil 2019; 38 (02) 97-101
• 19 Pomares G, Strugarek-Lecoanet C, Dap F, Dautel G. Bennett fracture: Arthroscopically assisted percutaneous screw fixation versus open surgery: Functional and radiological outcomes. Orthop Traumatol Surg Res 2016; 102 (03) 357-361
• 20 Leclère FMP, Jenzer A, Hüsler R. et al. 7-year follow-up after open reduction and internal screw fixation in Bennett fractures. Arch Orthop Trauma Surg 2012; 132 (07) 1045-1051
• 21 Demir E, Unglaub F, Wittemann M, Germann G, Sauerbier M. [Surgically treated intraarticular fractures of the trapeziometacarpal joint – a clinical and radiological outcome study] (German). Unfallchirurg 2006; 109 (01) 13-21
• 22 Lutz M, Sailer R, Zimmermann R, Gabl M, Ulmer H, Pechlaner S. Closed reduction transarticular Kirschner wire fixation versus open reduction internal fixation in the treatment of Bennett’s fracture dislocation. J Hand Surg [Br] 2003; 28 (02) 142-147
• 23 Timmenga EJ, Blokhuis TJ, Maas M, Raaijmakers EL. Long-term evaluation of Bennett’s fracture. A comparison between open and closed reduction. J Hand Surg [Br] 1994; 19 (03) 373-377
• 24 Kamphuis SJM, Greeven APA, Kleinveld S, Gosens T, Van Lieshout EMM, Verhofstad MHJ. Bennett’s fracture: Comparative study between open and closed surgical techniques. Hand Surg Rehabil 2019; 38 (02) 97-101
• 25 Middleton SD, McNiven N, Griffin EJ, Anakwe RE, Oliver CW. Long-term patient-reported outcomes following Bennett’s fractures. Bone Joint J 2015; 97-B [phone]