Surgical technique of dhs fixation dhs remains the gold standard for trochanteric fractures, and is a rather quick surgery with assured and predictable results. As much as you try, it is almost impossible to break a glass bangle a ringlike object in a single place it. Bennett fracture and fracture of trapeziometacarpal joint of the thumb. There is a paucity of literature comparing the outcomes of the various treatments, leaving the surgeon. Protect the axillary nerve during mobilization of both the lesser and greater tuberosities. Bennett described the anatomic details of the fracture and suggested that early diagnosis and treatment are imperative to prevent loss of function of this highly mobile joint. Reverse bennett fracturedislocation radiology reference. Neglected bennetts fracture dislocation in manual laborers. Bennett fracture an intraarticular fracture dislocation of the ulnar aspect of thumb1st metacarpal that extends into the carpometacarpal joint, in which a small fragment of the metacarpal bone stays articulated with the trapezium. When this injury occurs, the abductor pollicis longus pulls the thumb metacarpal proximally, dislocating it and causing an adducted posture of the thumb and consequent narrowing of the thumbweb space. Most bennett and rolando fractures are unstable and require surgical intervention. Physical examination and diagnostic imaging xray will confirm a bennetts fracture.
Bennett fracture repair is one of the problems for orthopedic surgeons, although there are a variety of clinical treatment for bennett fracture, no treatment strategy is widely accepted. I found basic surgical techniques so helpful that ive recommended it highly and gifted it to other med students. The width of this mentioned angle affects the localization of the fracture. Pdf bennett fracture and fracture of trapeziometacarpal joint of. Bennetts fracture fracture dislocation of the thumb in. The humeral stem will be 2 or 3mm smaller than the fracture sleeve allowing for a 23mm cement mantel. Surgical options for the management of neglected bennett fractures include intraarticular osteotomy, extraarticular metacarpal osteotomy, trapezial resection with or without tendon interpositional arthroplasty, fascial or implant arthroplasty, and arthrodesis of the trapeziometacarpal joint 27, 12. Arthroscopic assisted percutaneous screw fixation of bennett.
Pdf on jan 1, 2018, laurent obert and others published bennett fracture and fracture of. Bennett fracture is the most common fracture involving the base of the thumb. Ao surgery reference is a resource for the management of fractures, based on current clinical principles, practices and available evidence. This fracture typically results in a dorsally and radially displaced metacarpal shaft relative to the wellanchored volar ulnar fragment. In this highly illustrated book, the techniques of fracture reduction are clearly demonstrated using a stepwise approach with real time intraoperative photographs. This hand surgery is highly specialized, it derives from arthroscopic surgery for osteoarthritis of the base of the thumb rhizarthrosis. Template the fracture xray for proper diameter of fracture positioning sleeve implant figure 2. A bennetts fracture is the term for a fracture and dislocation of the base of the thumb. The nature of bennett s fracture makes visualization of the small proximal fragment which is usually.
Completely updated for its third edition, fractures, the acclaimed master techniques in orthopaedic surgery volume presents the most advanced, successful surgical techniques for fractures of the upper extremity, lower extremity, pelvis, and acetabulum. Bennett s fracture is named after edward hallaran bennett, professor of surgery 18371907, who first described it in 1882. However, most cases will require surgical intervention, either through closed reduction. Bennetts fracture, first metacarpal base fracture, open reduction internal fixation introduction. An orthopaedics textbook presented by duke university medical centers division of orthopaedic surgery, in conjunction with data trace internet publishing, llc, is a true head to toe, comprehensive discussion of orthopaedic topics. Jaaos journal of the american academy of orthopaedic surgeons. Bennetts fracture 1, 2 a bennetts fracture is an intraarticular fracture of the base of the first metacarpal with resultant dislocation of the first carpometacarpal joint. Surgical treatment of comminuted intraarticular fractures. In 1882, edward hallaran bennett, md, described the fracture of the base of the first metacarpal that bears his name. Bennett fracture partial intraarticular rolando fracture complete intraarticular severely comminuted fracture.
Bennetts fracture definition of bennetts fracture by. Bennetts fracture can be a result of injuries suffered during most of the contact sports such as boxing, rugby and soccer. It is pathologically and radiographically analogous to the bennett fracture of the thumb. A reverse bennett fracturedislocation is a fracturedislocation of the base of the 5 th metacarpal bone. Sep 07, 2018 in 1882, edward hallaran bennett, md, described the fracture of the base of the first metacarpal that bears his name. Physical examination and diagnostic imaging xray will confirm a bennett s fracture. Surgical proceduresmandibular fractures wikibooks, open. It is the most common base of metacarpal fracture 3. This means that an incision is made at the base of the thumb. Dorsal surgical approach is carried out without dissection of radial nerve. However, the optimal surgical approach is controversial. To describe and assess a tension band wiring technique for the treatment of bennett fractures and to compare this technique of open reduction and internal fixation versus closed reduction and percutaneous pinning. Articular fractures of the base of the 1 st metacarpal, also known as bennett fractures, are relatively common finger fractures. 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.
Treatment options range from conservative to surgical interventions. Bennett, rolando, tendon injuries linkedin slideshare. However, the level of stability attained is limited and the surgical wire is not appropriate where. This fracture typically results in a dorsally and radially displaced metacarpal shaft.
Epidemiology the vast majority of cases occur in me. The worlds foremost surgeons describe their preferred techniques in stepbystep detail, explain the indications and contraindications. Sports surgery bennetts fractures arthroscopy of the. The first is less invasive and involves inserting a surgical wire through the fracture site without making an incision. Immediate first aid consists of splinting the bone. Bennett fracture and fracture of trapeziometacarpal joint of the. A new cast technique helps elderly patients with ankle fractures no injury is enjoyable, but injuries do tend to become more dangerous as the body ages and is unable to heal itself as efficiently. A bennett fracture is a fracturedislocation of the thumb cmc joint. My skill came not from any intrinsic abilities of my own but rather from knowing how things were supposed to be done and what to pay attention to, which this book taught me. This book is distributed under the terms of the creative commons. Bennetts fracture bennetts fracture is a fracture of the base of the first metacarpal bone which extends into the carpometacarpal cmc joint. Rolando fracture is a threepart or comminuted intraarticular fracture dislocation of the base of the thumb proximal first metacarpal. This demanding hand surgery procedure is performed by specialized surgeons, it derives from the arthroscopic surgical procedure for rhizarthrosis arthritis of base of thumb.
Arthroscopically assisted percutaneous fixation of bennett. The specific fracture he described passed obliquely across the base of the bone, detaching the greater part of the articular surface. If there is a good alignment of the fracture fragments at postsurgical fixation, clinical. This book covers fracture reduction and fixation techniques for the treatment of adult fractures of the upper extremities. Bennett fracture definition of bennett fracture by medical. Surgical hardware, such as screws, pins or plates are used to align the fracture to allow it to heal in the correct position. Malunited bennett fracture with pain and disability is an indication for intraarticular osteotomy, interpositional arthoplasty, implant arthoplasty, arthrodesis. Because at this posture the energy from the bennett s fracture transmitted towards the thumb joint system cause the fracture. The best method of treatment for comminuted intraarticular fractures of the distal humerus has long been subject to debate, particularly when the fractures occur in.
Arthroscopic surgical treatment of a bennetts fracture. Exactech prosthetic proximal humeral fracture repair surgical technique. A new cast technique helps elderly patients with ankle. Jaaos journal of the american academy of orthopaedic.
Open reduction is indicated when reduction cannot be achieved by closed means more common with rolando fracture. In most cases, closed reduction and percutaneous pinning is indicated for bennett fractures. A bennetts fracture is an intraarticular fracture of the base of the first metacarpal arrow. Fracture reduction and fixation techniques springerlink. The main etiology of the bennett s fracture is an axial load is transmitted through a flexion of the thumb metacarpal joint during falling. Arthroscopic assisted percutaneous screw fixation of bennetts fracture. Bennett fracture dislocation is an intraarticular fracture of the base of the first metacarpal with resultant dislocation of the first carpometacarpal joint. The bennetts fracture is caused by a falling or any types of trauma affecting the patients hand and specifically the thumb joint. The fracture is unstable and inadequate treatment leads to osteoarthritis, weakness and loss of. Treatment of a bennett fracture using tension band wiring. As all joint fractures, finger fractures must be operated on as soon as they are displaced. Planning and reduction technique tn jtncture surgery.
Zimmer tea a tricepson approach to semiconstrained. The fracture is unstable and inadequate treatment leads to osteoarthritis, weakness and loss of function of the first carpometacarpal joint. A simple fracture is one in which there is no contact of the broken bone with the outer air, i. Bennett fracture definition of bennett fracture by. Know the causes, signs, treatment, exercises stretching and strengthening. The worlds foremost surgeons describe their preferred techniques in stepbystep detail. Operative treatment of bennetts fracture roman pavi1,2 and mario malovi1. Arthroscopically assisted percutaneous fixation of bennett fractures. The height determined here will be used throughout the surgical technique. They are most commonly the result of a traumatic downwards force through the thumb, normally seen in boxers and contact sports players.
As compared with the different surgical approaches advocated and commonly used, the direct volar approach affords clear direct exposure of the intraarticular fracture at the base of the thumb so aiding appropriate reduction and fixation of the fracture. Not all neglected bennett fractures require surgical intervention. Jun 20, 2018 bennett s fracture can be a result of injuries suffered during most of the contact sports such as boxing, rugby and soccer. Bennett fractures with less than 2 mm of disruption of articular congruity and minimal displacement may be treated by closed reduction. Zimmer tea a tricepson approach to semiconstrained total elbow arthroplasty zimmer coonradmorrey elbow cross section measurements. It might be associated with fractures influencing the adjacent carpal bone. Incidental findings of a malunion at the first carpometacarpal joint on a radiograph are.
A bennett s fracture is the term for a fracture and dislocation of the base of the thumb. The humeral head size can be estimated by overlaying the head templates over the contralateral humeral head. Arthroscopic assisted percutaneous screw fixation of bennett s fracture. It is quite unstable due to unopposed extensor carpi ulnaris pull on the fracture fragment, which causes migration and subluxation of the fragment. The mandible or the lower jaw bone behaves as a ring. Such is the case for elderly patients who break their ankle, also known as an ankle fracture. The form and severity of this fracture depends on the position of the hand at the moment of hitting the ground. Dec 18, 2015 bennett s fracture 1, 2 a bennett s fracture is an intraarticular fracture of the base of the first metacarpal with resultant dislocation of the first carpometacarpal joint. A bennett fracture is a common injury that involves an intraarticular fracture at the base of the first metacarpal. Arthroscopicassisted reduction and fixation of bennett type fractures of the thumb metacarpal allow for the confirmation of reduction as well as the assessment of the degree of chondral damage. A formal evaluation should be performed by an upper extremity orthopedic physician to determine proper diagnosis and treatment. Rolando fracture is a threepart or comminuted intraarticular fracturedislocation of the base of the thumb proximal first metacarpal.
The fracture is unstable, and with inadequate treatment leads to osteoarthritis, weakness andor loss of function of the first carpometacarpal joint. A bennetts fracture can also be treated with open reduction and internal fixation orif. Pdf arthroscopic assisted percutaneous screw fixation of. Bennetts fracture fracture of the base of the thumb. A bennett fracture is a fracture of the base of the thumb resulting from forced. Bennett fracture article about bennett fracture by the.
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. These hand fractures compromise the function of the trapezometacarpal joint, which is the main joint of the thumb. The audience is orthopedic and trauma surgeons such as general, hand, elbow, and shoulder specialists, as well as trainees in these areas. This intraarticular fracture is the most common type of fracture of the thumb, and is nearly always accompanied by some degree of subluxation or frank dislocation of the carpometacarpal joint. A new cast technique helps elderly patients with ankle fractures. It can be thought of as a comminuted bennett fracture. Bennetts fracture usually occurs due to an axial blow on a partiallyflexed first. Fractures of the 1st metacarpal base at the base of the thumb can damage the joint and lead to arthritis, weakness, and chronic pain. Bennett fracture an intraarticular fracturedislocation of the ulnar aspect of thumb1st metacarpal that extends into the carpometacarpal joint, in which a small fragment of the metacarpal bone stays articulated with the trapezium. Unique to this book is coverage of such surgical techniques as ulnohumeral arthroplasty, failed tennis elbow surgery, medical and lateral collateral ligament reconstruction, and. Injuries of the hand bennetts fracture disclocation, rolandos fracture and tendon injuries 2. Apr 06, 2015 fractures of the 1st metacarpal base at the base of the thumb can damage the joint and lead to arthritis, weakness, and chronic pain.
There are two main surgical methods for a bennetts fracture. Bennett described the fracturedislocation of the thumb metacarpal that bears his name in 1882 and again in 1886 fig. Aug 20, 2018 surgical technique of dhs fixation dhs remains the gold standard for trochanteric fractures, and is a rather quick surgery with assured and predictable results. Depending on the severity of the fracture, surgical treatment involves either closed reduction with percutaneous pinning or open reduction and internal fixation. Bennetts fracture dislocation, wheeless textbook of. Bennett fracture is an intraarticular fracture of the base of the first metacarpal with resultant dislocation of the first carpometacarpal joint. The fracture may need to be completed with an osteotome or elevator. A reverse bennett fracture dislocation is a fracture dislocation of the base of the 5 th metacarpal bone. Bennetts fracture dislocation wheeless textbook of orthopaedics. Content rich with thousands of pages in an easytoread outline format, accompanied by countless explanatory photos, drawings, radiological images, and videos, wheeless textbook of orthopaedics is the premier website for the industrious orthopaedic physician. There is often a connection between the calotte and the dorsal parts of the greater tuberosity, which is osteotomised close to the head fragment, leaving the tuberosity and rotator cuff fragments.
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