Articular fractures of the base of the thumb: Bennett’s fractures

Definition of articular fractures at the base of the thumb:

Articular fractures of the base of the 1st metacarpal, also known as Bennett fractures, are relatively common finger fractures. These hand fractures compromise the function of the trapezometacarpal joint, which is the main joint of the thumb. As all joint fractures, finger fractures must be operated on as soon as they are displaced.

Video of arthroscopic surgery of finger fracture:Hand surgery video showing arthroscopic treatment of a fracture of the thumb’s base/Toulouse specialist

 

Arthroscopic surgical treatment of a Bennett’s fracture:

This demanding hand surgery procedure is performed by specialized surgeons, it derives from the arthroscopic surgical procedure for rhizarthrosis (arthritis of base of thumb). It is performed on an outpatient basis under regional anaesthesia, with the patient comfortably lying on his or her back, the hand held vertically, the thumb under axial traction.   

Only four incisions less than 2 mm wide are required: 2 arthroscopic incisions, one posterolateral for optics and one anteromedial for instruments, and 2 more distal ones, determined previously by fluoroscopy, which will make it possible to position the 2 screws for fixation.

Arthroscopic thumb surgery for a Bennett’s fracture, preoperative X-ray, ToulouseArthroscopic thumb surgery for a Bennett fracture, skin surface, Toulouse

The joint is entered posterolaterally, the trapezium is visible below, and above, the first metacarpal bone whose fracture is apparent. The latter is displaced but already partly reduced by the axial traction applied.

Through the instrumental portal, the hematic synovial membrane can be evacuated, making the fracture more visible and post-operative pain and inflammation easier to reduce. Once synovectomy is completed, reduction is achieved by means of the trocart that exerts pressure on the base of the metacarpal bone.

The cannulated screws are then positioned under axial traction and checked at fluoroscopy. Here we can see the arthroscopic result, showing perfect reduction and the fracture site under satisfactory compression.

Arthroscopic thumb surgery for a Bennett’s fracture, operative setup, Toulouse

Arthroscopic thumb surgery for a Bennett’s fracture, arthroscopic control of Bennett’s fracture site, Toulouse

 

The 4 micro-incisions will be closed with Steri-strip and will not require any suture.
The postoperative x-ray shows perfect positioning of the osteosynthesis screws, which are buried and will not require secondary removal.

 

Arthroscopic thumb surgery for a Bennett fracture, postoperative X-ray, Toulouse

 

Recovery after arthroscopic finger fracture surgery

A splint must be worn for 3 weeks. Daily activities can resume at 3 weeks and rugby at 2 months.

Arthroscopic thumb surgery for a Bennett fracture, removable postoperative thermo-form splint to wear for 3 weeks, ToulouseArthroscopic thumb surgery for a Bennett fracture, aspect of scar after 1 month, Toulouse