Sports surgery – bennett’s fractures

Definition of Bennett's fractures:

In sports surgery, articular fractures of the base of the first metacarpal bone (thumb), also called Bennett’s fractures, are relatively common. Often, these fractures result from a blow, deliberate or not; these sports injuries are thus easily found in combat sports but also after accidental falls onto the thumb column in dangerous sports.

Articular fracture of the thumb’s base, Bennett's fracture, resulting from violent blow to the thumb, ToulouseArticular fracture of the thumb’s base, combat sports, more often caused by receiving a blow than dealing it

 

These sports injuries with a fracture of the thumb’s base compromise the function of the trapezometacarpal joint, which is the main joint of the thumb. As all joint fractures, these require surgery as soon as they are displaced, all the more so in athletes

Video of Bennett's fractures:

Video of arthroscopic sports surgery for a fracture of the joint at the base of the thumb / Toulouse specialist

Surgical treatment of Bennett’s fractures:

This hand surgery is highly specialized, it derives from arthroscopic surgery for osteoarthritis of the base of the thumb (rhizarthrosis). 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 4 incisions less than 2 mm wide are required: Two arthroscopic incisions, one posterolateral for optics and one anteromedial for instruments, and two more distal ones, determined previously at fluoroscopy, which will make it possible to position the two screws for osteosynthesis.

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

 

The thumb’s joint is entered posterolaterally, the trapezium is visible below, and above, the first metacarpal bone and its fracture which is apparent. The latter is displaced but already partly reduced by axial traction.

The instrumental portal allows the hematic synovia to be evacuated, improving fracture visualization and minimizing post-operative pain and inflammation. Once synovectomy is complete, 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 then verified at arthroscopy. Here we can see the result at arthroscopy, with the fracture site perfectly reduced and under proper reduction.

Arthroscopic thumb surgery for a Bennett fracture, operative setup, ToulouseArthroscopic thumb surgery for a Bennett fracture, arthroscopic control of Bennett fracture site, Toulouse

The 4 micro-incisions will be closed with Steri-strip and will not require any stitches.
Post-operative 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 Bennett’s fracture surgery

A splint must be worn for 3 weeks. Daily activities can resume 3 weeks after surgery and rugby after 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