Management of neglected Bennett fracture in manual laborers by tension fixation

Mostafa Mahmoud, Sherif El Shafie, Ron M G Menorca, John C Elfar
Journal of Hand Surgery 2014, 39 (9): 1728-33

PURPOSE: To report the results of open reduction and internal fixation (ORIF) of Bennett fractures in young, active patients using a K-wire and wire loop construct to achieve anatomical reduction and to allow return to manual labor.

METHODS: In this prospective series, we treated 10 male manual laborers (mean age, 30 y; range, 20-44 y) with Bennett fractures diagnosed after a minimum of 12 weeks (mean, 16 wk; range, 12-18 wk). ORIF using 2 K-wires with a wire loop and a neutralizing transarticular K-wire was performed with direct articular visualization. Patients were evaluated for range of motion, grip strength, and pinch strength, and a visual analog scale score rated pain before surgery and 12 months later.

RESULTS: The mean follow-up was 16 months (range, 12-36 mo). The average visual analog scale improved from 6 to 2, mean palmar abduction improved from 15° to 40°, mean radial abduction increased from 22° to 39°, average pinch strength improved from 9.9 kg to 15.5 kg, and average grip strength increased from 34 kg to 49 kg. Complications included transient irritation of the radial sensory nerve or lateral cutaneous nerve of the forearm in 3 patients, pin track granuloma formation in 2 patients, and marginal osteophyte formation in 2 patients. Union was achieved in all 10 patients, and 9 patients returned to their previous manual labor occupation.

CONCLUSIONS: Our results suggest that neglected Bennett fractures can be effectively managed by ORIF using K-wires and a wire loop without compromising strength or motion. This technique reliably restored the anatomy and provided adequate thumb motion and strength to allow a return to manual labor.


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