Bennett fracture: Arthroscopically assisted percutaneous screw fixation versus open surgery: Functional and radiological outcomes

G Pomares, C Strugarek-Lecoanet, F Dap, G Dautel
Orthopaedics & Traumatology, Surgery & Research: OTSR 2016, 102 (3): 357-61

BACKGROUND: Arthroscopically assisted percutaneous screw fixation has been introduced to decrease the invasiveness of treatments for intra-articular fractures.

HYPOTHESIS: Arthroscopically assisted percutaneous screw fixation of Bennett fracture simplifies the postoperative course compared to open surgery.

MATERIAL AND METHODS: Twenty-one Bennett fractures detaching at least one-third of the joint surface were studied retrospectively. Among them, 11 were managed by percutaneous screw fixation and 10 by open surgery. Follow-up was at least 12 months. Clinical and radiological evaluations were performed to assess the development of complications, tourniquet time, immobilisation time, sick-leave time, QuickDASH score, Kapandji score, grip strength, pinch strength, return to work activities, intra-articular screw migration, inadequate reduction, non-union, and joint remodelling.

RESULTS: The percutaneous group had significantly shorter immobilisation (P<0.0001) and tourniquet (P=0.0068) times. The number of complications was 1 in the percutaneous group and 6 in the open-surgery group. Whereas no adverse radiographic outcomes were found in the percutaneous group, the open-surgery group had 2 cases of inadequate reduction, 3 cases of joint remodelling, and 4 cases of intra-articular screw migration. The number of patients unable to return to their previous work activities was 1 (9%) in the percutaneous group and 3 (30%) in the open-surgery group.

DISCUSSION: Arthroscopically assisted percutaneous screw fixation seems to ensure a simpler postoperative course, with fewer clinical and radiographic complications, as well as shorter tourniquet and immobilisation times.

LEVEL OF EVIDENCE: IV, retrospective comparative study.

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