BENNETT FRACTURE

Abstract

Introduction: The intra-articular fracture separating the palmar ulnar aspect of the base of the first metacarpal from the rest of the first metacarpal is called Bennett's fracture. Injuries are usually caused by axial loads on the partially flexed metacarpal bones. Radiographs are needed to evaluate these injuries and to schedule surgery to relieve them, since such fractures are assumed to be unstable. Surgical treatment of these fractures alters depending on the extent of the injury. It may include closed reduction with percutaneous fixation or open reduction with fixation or interfragmentary fixation. With good fracture localization and fixation, the postoperative outcome is usually good.

Objective: to detail the current information related to Bennett's fracture, presentation, evaluation, comparison with Rolando's fracture, in addition to the diagnosis and treatment of the disease.

Methodology: a total of 28 articles were analyzed in this review, including review and original articles, as well as clinical cases, of which 18 bibliographies were used because the other articles were not relevant to this study. The sources of information were PubMed, Google Scholar and Cochrane; the terms used to search for information in Spanish, Portuguese and English were: Bennett fracture. Bennett's, fratura da base do primer metacarpiano.

Results: Anteroposterior, lateral and oblique projections are common when taking radiographs of the hand, however Robert's view can reveal more details about the injury. Both Bennett's and Rolando's fractures present the same pathogenic mechanism however the damaging force is of greater magnitude than in Bennet's fractures.

K-wire fixation is better than plate and/or screw osteosynthesis as a treatment because of the benefit of keeping costs down without harming the patient in the long term. Direct visualization is the most accurate method to assess joint separation and articular pitch, PA, AP and lateral projections on fluoroscopic examination may not be sufficient to determine the final position of a reduced Bennett fracture.

Conclusions: Although there is no consensus on which treatment is best, surgical treatment of Bennett fractures is usually used because closed reduction and cast immobilization without internal fixation are often unstable due to deforming forces. Indications for surgical treatment for fractures of the base of the first metacarpal include extra-articular fractures with more than 30 degrees of angulation after reduction; loss of reduction after non-operative treatment; and intra-articular fractures: displaced Bennett fractures greater than 1 mm or any Rolando fracture.The arthroscopically assisted screw fixation of Bennett reported fewer complications, shorter immobilization time and shorter tourniquet time.