Objectives: Bennett's fracture, the most common intra-articular fracture occurring at the base of the
thumb, accounts for less than 1% of all hand fractures. It typically results from specific traumatic
mechanisms, deforming forces, and ligamentous injuries. To compare the functional outcomes and
sequelae in patients with Bennett's fracture treated surgically using: Open reduction and internal screw
fixation, closed reduction and percutaneous fixation, arthroscopy-assisted reduction and screw fixation.
Methods: A systematic literature review was conducted to identify studies on Bennett's fracture dislocations in
patients over 18 years of age without additional injuries. Searches were performed in PubMed, Scopus, Cochrane
Central, Web of Science, Scielo, Lilacs, Oneme, and Epistemonikos databases, with language restrictions in
English, French, Spanish, Portuguese, Italian, and German, and no date restrictions. Primary outcome variables
included measures of functionality and secondary outcomes such as pain, stiffness, and osteoarthritis.
Results: A total of 18 studies met the selection criteria, with most being retrospective (94.45%). Pain measures
were reported in 77.78% of the studies, predominantly using the VAS (min=0 and max=2). All techniques seemed
to achieve similar functional outcomes. The main difference was the pain registered at follow-up, mainly by patients
treated with open reduction. Osteoarthritis appeared as a common consequence of these fractures, regardless of
the treatment type -excluding arthroscopy-assisted reduction as there was not enough data.
Conclusion: The three techniques had similar functional outcomes. Closed reduction and percutaneous fixation
appear to result in less pain; however, both closed reduction with percutaneous fixation and open reduction with
internal screw fixation have similar rates of osteoarthritis at follow-up. Unfortunately, there is insufficient data to
evaluate arthroscopy-assisted reduction with screw fixation, suggesting the need for rigorous follow-up in patients
undergoing this surgical intervention.
Level of evidence: III |
- Dalcortivo RL, Yarbrough BA, Congiusta D V, Ahmed IH, Vosbikian MM. Anesthesia Type and Short-Term Outcomes in Open Treatment of Hand Fractures. Arch Bone Jt Surg. 2024; 12(10):721-727. doi:10.22038/ABJS.2024.67440.3200.
- Padilla Becerra F. Aplicaciones de la osteosíntesis en la cirugía de mano. Medigraphic Artemisa. 2006;2(2000):18-27.
- Weintraub MD, Hansford BG, Stilwill SE, et al. Avulsion Injuries of the Hand and Wrist. Radiographics. 2020; 40(1):163-180. doi:10.1148/rg.2020190085.
- Malisorn S. The Current Concept and Evidence-Based Practice in the Base of the First Metacarpal Bone Fracture. Cureus. 2024; 16(1):e51600. doi:10.7759/cureus.51600.
- Rivlin M, Fei W, Mudgal CS. Bennett Fracture. J Hand Surg Am. 2015; 40(8):1667-1668. doi:10.1016/j.jhsa.2015.05.017.
- Kamphuis SJM, Greeven APA, Kleinveld S, Gosens T, Van Lieshout EMM, Verhofstad MHJ. Bennett’s fracture: Comparative study between open and closed surgical techniques. Hand Surg Rehabil. 2019; 38(2):97-101. doi:10.1016/j.hansur.2018.11.003.
- Strauch RJ, Behrman MJ, Rosenwasser MP. Acute dislocation of the carpometacarpal joint of the thumb: an anatomic and cadaver study. J Hand Surg Am. 1994; 19(1):93-98. doi:10.1016/0363-5023(94)90229-1.
- Martínez Martín AA, Herrero Barcos L, Cuenca Espiérrez J, Herrera Rodríguez A. Resultado de la osteosíntesis abierta en el tratamiento de las fracturas de Bennett. Rev la Soc Andaluza Traumatol y Ortop. 2002; 22(2):130-133.
- Brazier J, Moughabghab M, Migaud H, Fontaine C, Elia A, Tillie B. Articular fractures of the base of the first metacarpal. Comparative study of direct osteosynthesis and closed pinning. Ann Chir Main Memb Super. 1996; 15(2):91-99. doi:10.1016/s0753-9053(96)80014-7.
- Greeven APA, Van Groningen J, Schep NWL, Van Lieshout EMM, Verhofstad MHJ. Open reduction and internal fixation versus closed reduction and percutaneous fixation in the treatment of Bennett fractures: A systematic review. Injury. 2019; 50(8):1470-1477. doi:10.1016/j.injury.2019.06.027.
- Lutz M, Sailer R, Zimmermann R, Gabl M, Ulmer H, Pechlaner S. Closed reduction transarticular Kirschner wire fixation versus open reduction internal fixation in the treatment of Bennett’s fracture dislocation. J Hand Surg Am. 2003; 28 B (2):142-147. doi:10.1016/S0266-7681(02)00307-8.
- Higgins J,Green S. Manual Cochrane de Revisiones Sistemáticas de Intervenciones, in Spanish . In: Cochrane Handbook for Systematic Reviews of Interventions; 2011.
- Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021:372:n71. doi: 10.1136/bmj.n71.
- Murad MH, Sultan S, Haffar S, Bazerbachi F. Methodological quality and synthesis of case series and case reports. BMJ evidence-based Med. 2018; 23(2):60-63. doi:10.1136/bmjebm-2017-110853.
- Lutz M, Angermann P, Sailer R, Kathrein A, Gabl M, Pechlaner S. Closed reduction and percutaneous K-wire fixation of Bennett’s fracture dislocation. Handchir Mikrochir Plast Chir. 2002; 34(1):41-48. doi:10.1055/s-2002-22106.
- Adi M, Miyamoto H, Taleb C, et al. Percutaneous fixation of first metacarpal base fractures using locked K-wires: a series of 14 cases. Tech Hand up Extrem Surg. 2014; 18(2):77-81. doi:10.1097/BTH.0000000000000040.
- Bouaicha W, Jlidi M, Bellila S, et al. Comparative study of Iselin’s technique for the treatment of Bennett’s fracture with large and small fragments. SAGE open Med. 2022; 10:20503121221105570. doi:10.1177/20503121221105569.
- Demir E, Unglaub F, Wittemann M, Germann G, Sauerbier M. [Surgically treated intraarticular fractures of the trapeziometacarpal joint -- a clinical and radiological outcome study]. Unfallchirurg. 2006; 109(1):13-21. doi:10.1007/s00113-005-0988-y.
- Greeven APA, Alta TDW, Scholtens REM, de Heer P, van der Linden FM. Closed reduction intermetacarpal Kirschner wire fixation in the treatment of unstable fractures of the base of the first metacarpal. Injury. 2012; 43(2):246-251. doi:10.1016/j.injury.2011.10.038.
- Middleton SD, McNiven N, Griffin EJ, Anakwe RE, Oliver CW. Long-term patient-reported outcomes following Bennett’s fractures. Bone Joint J. 2015; 97-B (7):1004-1006. doi:10.1302/0301-620X.97B7.35493.
- Obert L, Garbuio P, Gérard F, Ridoux PE, Tropet Y, Vichard P. [Recent, closed trapezio-metacarpal luxation, treated by pinning.Apropos of 7 cases with a median follow-up of 8 years]. Ann Chir Main Memb Super. 1997; 16(2):102-110. doi:10.1016/s0753-9053(97)80027-0.
- Sawaizumi T, Nanno M, Nanbu A, Ito H. Percutaneous leverage pinning in the treatment of Bennett’s fracture. J Orthop Sci. 2005; 10(1):27-31. doi:10.1007/s00776-004-0856-6.
- Huang H-K, Huang Y-C, Hung W-C, Yin C-Y, Lo I-N, Wang J-P. Outcomes of Percutaneous Pinning for Interfragmentary Fixation in Treating Bennett Fractures with Tiny Avulsion Fragments. Orthopedics. 2023; 46(2):103-107. doi:10.3928/01477447-20221031-06.
- Brüske J, Bednarski M, Niedźwiedź Z, Zyluk A, Grzeszewski S. The results of operative treatment of fractures of the thumb metacarpal base. Acta Orthop Belg. 2001; 67(4):368-373.
- Kjaer-Petersen K, Langhoff O, Andersen K. Bennett’s fracture. J Hand Surg Br. 1990; 15(1):58-61. doi:10.1016/0266-7681_90_90049-a.
- Sälgeback S, Eiken O, Carstam N, Ohlsson NM. A study of Bennett’s fracture. Special reference to fixation by percutaneous pinning. Scand J Plast Reconstr Surg. 1971; 5(2):142-148. doi:10.3109/02844317109042955.
- Levy V, Mazzola M, Gonzalez M. Intra-Articular Fracture of the Base of the First Metacarpal Bone: Treatment Through a Volar Approach. Hand (N Y). 2018; 13(1):90-94. doi:10.1177/1558944716685828.
- Zhang X, Shao X, Zhang Z, Wen S, Sun J, Wang B. Treatment of a Bennett fracture using tension band wiring. J Hand Surg Am. 2012; 37(3):427-433. doi:10.1016/j.jhsa.2011.12.025.
- Zemirline A, Lebailly F, Taleb C, Facca S, Liverneaux P. Arthroscopic assisted percutaneous screw fixation of
Bennett’s fracture. Hand Surg. 2014; 19(2):281-286. doi:10.1142/S0218810414970053.
- Pomares G, Strugarek-Lecoanet C, Dap F, Dautel G. Bennett fracture: Arthroscopically assisted percutaneous screw fixation versus open surgery: Functional and radiological outcomes. Orthop Traumatol Surg Res. 2016; 102(3):357-361. doi:10.1016/j.otsr.2016.01.015.
- Talari K, Goyal M. Retrospective studies - utility and caveats. J R Coll Physicians Edinb. 2020; 50(4):398-402. doi:10.4997/JRCPE.2020.409.
- Singer BR, McLauchlan GJ, Robinson CM, Christie J. Epidemiology of fractures in 15,000 adults: the influence of age and gender. J Bone Joint Surg Br. 1998; 80(2):243-248. doi:10.1302/0301-620x.80b2.7762.
- Pellegrini VDJ. Fractures at the base of the thumb. Hand Clin. 1988; 4(1):87-102.
- Papadatou-Pastou M, Ntolka E, Schmitz J, et al. Human handedness: A meta-analysis. Psychol Bull. 2020; 146(6):481-524. doi:10.1037/bul0000229.
- Chung KC, Spilson S V. The frequency and epidemiology of hand and forearm fractures in the United States. J Hand Surg Am. 2001; 26(5):908-915. doi:10.1053/jhsu.2001.26322.
- Avery DM 3rd, Rodner CM, Edgar CM. Sports-related wrist and hand injuries: a review. J Orthop Surg Res. 2016; 11(1):99. doi:10.1186/s13018-016-0432-8.
- Goru P, Haque S, Verma GG, Mustafa A, Ebinesan A. Bennett’s Fracture Management: A Systematic Review of Literature. Cureus. 2022; 14(11):e31340. doi:10.7759/cureus.31340.
- Hudak PL, Amadio PC, Bombardier C, et al. Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder, and head). American journal of industrial medicine. 1996; 29(6):602-8.
- Daher M, Roukoz S, Ghoul A, Tarchichi J, Aoun M, Sebaaly A. Management of Bennett’s fracture: A systematic review and meta-analysis. JPRAS open. 2023; 38:206-216. doi:10.1016/j.jpra.2023.09.010.
- Tsang P, Walton D, Grewal R, MacDermid J. Validation of the QuickDASH and DASH in Patients with Distal Radius Fractures through Agreement Analysis. Arch Phys Med Rehabil. 2017; 98(6):1217-1222.e1. doi:10.1016/j.apmr.2016.11.023.
- Graham DJ, Watson A, Taylor F, Sivakumar B. Screw and Suspension Fixation for Bennett Fractures. J hand Surg Glob online. 2023; 5(2):206-210. doi:10.1016/j.jhsg.2022.10.007.
- Torres Fuentes CE, Meneses Argalle JD, Romero León CA. Arthroscopic-Assisted Treatment of Bennett Fractures: A Potentially Advantageous Operative Procedure? Hand (N Y). 2023:15589447231211602. doi: 10.1177/15589447231211602.
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