Resolution
Diagnosis
Bennett fracture (circles, Figure 2). Such a fracture occurs in axial loading of a flexed thumb, often from a fall or blow from an object.
Learnings
Closed reduction and thumb spica cast immobilization are effective in the treatment of Bennett fractures if the reduction can be maintained. The closed reduction technique consists of thumb traction combined with metacarpal extension, pronation, and abduction. Direct downward pressure is applied to the dorsal radial metacarpal base. The strong pull of the abductor pollicis longus muscle frequently leads to displacement, necessitating open reduction and internal fixation or closed reduction with percutaneous pinning. Articular incongruity of >1 mm or persistent subluxation of the carpometacarpal joint after closed reduction indicates the need for surgical treatment.
Published on
Clinical Challenge: September, 2015
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