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Simultaneous trapezium and Bennett's fractures
Simultaneous
trapezium and Bennett’s fractures
P. J. Radford, MA, FRCS, D. T. Wilcox, BSc, MB, BS, and B. J. Holdsworth, Nottingham, England
From the Department of Fracture and Orthopaedic Surgery, University Hospital, Queen’s Medical Centre, Nottingham, England. Received for publication Oct. 14, 1991.
June 25, 1991; accepted
in revised form
No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. Reprint requests: Philip J. Radford. MA, FRCS, Department of Fracture and Orthopaedic Surgery, University Hospital, Queen’s Medical Centre, Nottingham NG7 2UH, England. 3/l/34856
FRCS,
e recently treated a patient who had a combined Bennett’s fracture and fracture of the body of the trapezium. The former is quite common, the latter rather rare. We have been unable to find a previous report of a similar injury. CASE REPORT A 19-year-old man fell off his bicycle, injuring his right dominant hand at the basal joint of the thumb. Physical examination showed tenderness, swelling, and immobility due to pain at the joint. An x-ray film (Fig. 1) showed a typical
Fig. 1. Two views of base of thumb showing displaced Bennett’s fracture and comminuted fracture of trapezium with disruption of both trapeziometacarpal and the trapezioscaphoid joint surfaces.
THE JOURNAL
OF HAND SURGERY
621
622
The Journal of HAND SURGERY
Radford et al.
Bennett’s fracture and a comminuted fracture of the body of the trapezium. Surgical exploration was undertaken within 24 hours of injury. The Bennett’s fracture was reduced and fixed with a single 2 mm A0 cortical screw. The trapezium fracture comprised two large and two smaller fragments. It was reduced and held with a 2 mm screw, a Kirschner (K-) wire to buttress the joint surface, and a suture to hold the smaller fragments in place (Fig. 2). After 2 weeks of plaster immobilization, supervised gentle mobilization was commenced. The K-wire was removed at 4 weeks. The patient regained full motion by 8 weeks and at 1 year was free of symptoms with x-ray evidence of excellent healing (Fig. 3).
Discussion
Fig. 2. Postoperative x-ray film showing restoration of articsurface anatomy.
Fig. 3. A and B, Clinical photographs
Bennett’s fracture is well described,’ and there are at least 19 different methods of treatment. However, the common denominator of success is achievement and maintenance of an anatomic reduction.* Crawford3 has advocated the method of screw fixation that we used. On the other hand, fractures of the trapezium comprise only 3.5% to 5% of all carpal fractures.4 There are three types: those of the body, of the palmar ridge, and avulsion.’ The mechanism of trapezial fracture is either longitudinal compression impaction of the first metacarpal or a nutcracker phenomenon of the trapezium caught between the hyperextended metacarpal and the scaphoid or radial styloid.’ Our patient seems to have had a combination of the two.
of hands at 1 year showing full symmetric range of motion.
Vol. 17A, No. 4 July 1992
Simultaneous trapezium and Bennett’s fracture
623
C, Clinical photograph. D, X-ray film showing bony union and preservation of normal articular anatomy on both sides of trapezium.
Fig. (cont’d).
One can expect a poor result from nonoperative treatment of displaced trapezia1 fractures5. 6 with persistent pain and loss of basal joint mobility. Most of these fractures are held with K-wires, and we could find only one previous report of the use of a screw to hold the fracture.’ Our case reinforces the adage that achievement and maintenance of an anatomic reduction followed by proper remobilization techniques may be expected to give a good result. REFERENCES 1. Green DP, Rowland SA. Fractures and dislocations in the hand. In: Rockwood CA, Green DP, eds. Fractures in adults. vol 1. Philadelphia: JB Lippincott, 1984:355-8. 2. O’Brien ET. Fractures of the metacarpals and phalanges.
3.
4.
5.
6. 7,
In: Green DP, ed. Operative hand surgery. 2nd ed. New York: Churchill Livingstone, 1988:765-70. Crawford GP. Screw fixation for certain fractures of the phalanges and metacarpals. J Bone Joint Surg 1976; 58A:487-92. Cordrey LJ, Ferrer-Torells M. Management of fractures of the greater multangular. J Bone Joint Surg 1960;42A:lll l-8. Taleisnik J. Fractures of the carpal bones. In: Green DP, ed. Operative Hand Surgery. vol 2. 2nd ed. New York: Churchill Livingstone, 1988;848-50. Jones WA, Ghorbal MS. Fractures of the trapezium: a report on three cases. J HANDSURG 1985;10B:227-30. Holdsworth BJ, Shackleford I. Fracture dislocation of the trapezioscaphoid joint-the missing link? J HAND SURG 1987;12B:40-2.
trapezium and Bennett’s fractures
P. J. Radford, MA, FRCS, D. T. Wilcox, BSc, MB, BS, and B. J. Holdsworth, Nottingham, England
From the Department of Fracture and Orthopaedic Surgery, University Hospital, Queen’s Medical Centre, Nottingham, England. Received for publication Oct. 14, 1991.
June 25, 1991; accepted
in revised form
No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. Reprint requests: Philip J. Radford. MA, FRCS, Department of Fracture and Orthopaedic Surgery, University Hospital, Queen’s Medical Centre, Nottingham NG7 2UH, England. 3/l/34856
FRCS,
e recently treated a patient who had a combined Bennett’s fracture and fracture of the body of the trapezium. The former is quite common, the latter rather rare. We have been unable to find a previous report of a similar injury. CASE REPORT A 19-year-old man fell off his bicycle, injuring his right dominant hand at the basal joint of the thumb. Physical examination showed tenderness, swelling, and immobility due to pain at the joint. An x-ray film (Fig. 1) showed a typical
Fig. 1. Two views of base of thumb showing displaced Bennett’s fracture and comminuted fracture of trapezium with disruption of both trapeziometacarpal and the trapezioscaphoid joint surfaces.
THE JOURNAL
OF HAND SURGERY
621
622
The Journal of HAND SURGERY
Radford et al.
Bennett’s fracture and a comminuted fracture of the body of the trapezium. Surgical exploration was undertaken within 24 hours of injury. The Bennett’s fracture was reduced and fixed with a single 2 mm A0 cortical screw. The trapezium fracture comprised two large and two smaller fragments. It was reduced and held with a 2 mm screw, a Kirschner (K-) wire to buttress the joint surface, and a suture to hold the smaller fragments in place (Fig. 2). After 2 weeks of plaster immobilization, supervised gentle mobilization was commenced. The K-wire was removed at 4 weeks. The patient regained full motion by 8 weeks and at 1 year was free of symptoms with x-ray evidence of excellent healing (Fig. 3).
Discussion
Fig. 2. Postoperative x-ray film showing restoration of articsurface anatomy.
Fig. 3. A and B, Clinical photographs
Bennett’s fracture is well described,’ and there are at least 19 different methods of treatment. However, the common denominator of success is achievement and maintenance of an anatomic reduction.* Crawford3 has advocated the method of screw fixation that we used. On the other hand, fractures of the trapezium comprise only 3.5% to 5% of all carpal fractures.4 There are three types: those of the body, of the palmar ridge, and avulsion.’ The mechanism of trapezial fracture is either longitudinal compression impaction of the first metacarpal or a nutcracker phenomenon of the trapezium caught between the hyperextended metacarpal and the scaphoid or radial styloid.’ Our patient seems to have had a combination of the two.
of hands at 1 year showing full symmetric range of motion.
Vol. 17A, No. 4 July 1992
Simultaneous trapezium and Bennett’s fracture
623
C, Clinical photograph. D, X-ray film showing bony union and preservation of normal articular anatomy on both sides of trapezium.
Fig. (cont’d).
One can expect a poor result from nonoperative treatment of displaced trapezia1 fractures5. 6 with persistent pain and loss of basal joint mobility. Most of these fractures are held with K-wires, and we could find only one previous report of the use of a screw to hold the fracture.’ Our case reinforces the adage that achievement and maintenance of an anatomic reduction followed by proper remobilization techniques may be expected to give a good result. REFERENCES 1. Green DP, Rowland SA. Fractures and dislocations in the hand. In: Rockwood CA, Green DP, eds. Fractures in adults. vol 1. Philadelphia: JB Lippincott, 1984:355-8. 2. O’Brien ET. Fractures of the metacarpals and phalanges.
3.
4.
5.
6. 7,
In: Green DP, ed. Operative hand surgery. 2nd ed. New York: Churchill Livingstone, 1988:765-70. Crawford GP. Screw fixation for certain fractures of the phalanges and metacarpals. J Bone Joint Surg 1976; 58A:487-92. Cordrey LJ, Ferrer-Torells M. Management of fractures of the greater multangular. J Bone Joint Surg 1960;42A:lll l-8. Taleisnik J. Fractures of the carpal bones. In: Green DP, ed. Operative Hand Surgery. vol 2. 2nd ed. New York: Churchill Livingstone, 1988;848-50. Jones WA, Ghorbal MS. Fractures of the trapezium: a report on three cases. J HANDSURG 1985;10B:227-30. Holdsworth BJ, Shackleford I. Fracture dislocation of the trapezioscaphoid joint-the missing link? J HAND SURG 1987;12B:40-2.