This document discusses Bennett's fracture, which is an intra-articular fracture at the base of the first metacarpal. It occurs due to an axial blow to a partially flexed thumb. The anatomy and mechanism of injury are described. Treatment options include closed reduction, closed reduction with internal fixation using K-wires, and open reduction with internal fixation using screws if there is joint incongruity. Gamekeeper's thumb, which is a ulnar collateral ligament injury of the thumb metacarpophalangeal joint, and its treatment are also summarized.

1. BENNETT’S FRACTURE
Dr. Lokesh Sharoff

3. • Irish surgeon Edward
Bennett in 1882
• Base of 1st MC # intra-
articular #s

5. Mechanism of injury
 Axial blow directed against
partially flexed MC
 Usually in fist fighters

6. ANATOMY
• Base of MC pulled radially & dorsally by
APL while the distal attachment of the
adductor levers pulls the base further
dorsally
• Avulsion # :Smaller volar lip fragment
remains attached to the AOL that anchors
the fragment to tubercle of trapezium

9. VARIABLES
• Two primry variables
• Size of the volar lip fragment
• Amt of displacement of shaft

10. Clinical features
• H/o injury / blow
• Swelling and pain in the carpometacarpal
region
• Painful and restricted movement at the first
carpometacarpal joint. Pain on gripping,
dorsiflexion, etc.
• Thumb appears shortened.

11. Normal ROM of 1st
CMC
-Flexion –Extension Arc of 50*
-Abduction-Adduction arc of 40*
-Pronation-Supination arc of 15*

12. DIAGNOSIS
• Intra articular status
• AP & Oblique
• Billing & Gedda’s lateral view

13. Billings and Gedda view
• True lateral view (by Billing and Gedda's
technique) hand pronated by 15-20° on the
cassette and the tube is directed obliquely
15° distal to proximal, centering at the
carpometacarpal joint.
• Characteristic fracture is seen.

14. ASSOCIATIONS
- # Trapezium
- Ulnar collateral ligament injury

15. Treatment options
- C.R.
- CRIF
- ORIF

16. CR - Indications
- Undisplaced
- Minimally displaced
- Old age with medical co-morbidities

17. CR- Method
- By giving a cast and leaving the IP joint free
for 6 weeks.
- In 1st
CMC joint- loss of stability is more of
a complication than stiffness.

18. CRIF - Indications
- Pure #s in which reduction can be achieved
with no dislocation

19. CRIF - method
- Manual traction is giving by acting against
the muscle forces and direct pressure over the
base of 1st
MC
- K-wire is passed – transfixed to carpus

20. Open reduction - Indications
- # dislocations
- Open #s
- Failed CR
- Tissue interposition
- Late unreduced dislocation

21. ORIF - method
- Without ligament reconstruction
- With ligament reconstruction- WAGNER
technique –split FCR tendon

22. TREATMENT cont’d
• Check X rayIf >3mm incongruity in
joint go for ORIF
• ORIF :with cortical screws probably
the best
• Technically more demanding, more
secure & active range of motion

24. POST OP Tt
• Thumb spica cast x 4wks
• 10 th day S/R & window for pintract care

25. COMPLICATIONS
• Malunionrec/persistent subluxation of
trapezio MC jt
• CLINKSCALES closing wedge osteotomy

26. ROLANDO FRACTURE

28. • ROLANDO 1910
• TYPE 2 THUMB MC #
• BENNETT’S # + LARGE DORSAL
FRAGMNT
• #BASE OF 1ST
MC WITH Y/T SHAPED
INTRA ARTICULAR FRAGMENT
• PROBABLY A COMMINUTED
BENNETT’S FRACTURE

29. • A difficult # to treat but least common among
adult thumb MC #
• ORIF attempted only if single large dorsal & volar
fragments
• ORIF of comminuted #s ----experienced surg in
AO techniques
• Traction& Ex fix are reasonable alternatives
• If joint surface incongrous on check x ray
immobilise the thumb for a minimal period &
early active motion to remold badly distorted
articular surface

30. GAME KEEPER’S
THUMB

31. • C/c laxity of UCL without h/o trauma as
occupational deformity in British game keepers
• MC among Skiers due to fall on an outstretched
handA/c UCL injurySkier’s thumb
• MOI: valgus or abdn force probably combined
with hyper extension
• UCL,dorsal capsule,ulnar aspect of volar plate&
occasionally rent in adductor aponeurosis with
avulsion #s of its insertion on the volar base of
prox phalanx

34. • Stener lesion : in total tear of UCL addr
aponeurosis interposed; prevents adequate
healing
• CLINICAL FEATURES: Painful swollen
MP joint, max tenderness ulnar aspect.
• Differentiate partial & total tear difficult but
important.

35. DIAGNOSIS
• Stener lesion : tender at ucl just prox to MP jnt
• Valgus stress at MCP in flexion & ext and
compare amt of radial deviation with opposite side
under LA/Wrist block.
• VST with radiological support >5-15deg +ve[in
30* flexion]
• Difficult to suspect & diagnose when asso with
prox phalax#
• Routine x ray before VST to r/o a]shear # .rad
side of head of MC b]prox phalanx, ulnar aspect
of base

39. DIAGNOSIS cont’d
• MRI: 100% sensitive to stener lesion
• USG : Skilled person can detect stener
lesion

40. DIFFERENTIAL DIAGNOSIS
- Boxers knuckle – it is a dorsal tear in the
capsule of the MCP joint.
- Sesamoid # - to take oblique views

41. Indications
- Non-operative
-RCL Injuries
- Volar or dorsal Subuluxation
- Boxers knuckle
-Sesamoid #
-Partial ucl injuries

42. Indications
-Operative
-Steners lesion
-Unreduced dislocation
-Failed conservative rx
-Complete lig mid-substance tear
-Complete tear with bony avulsion

43. TREATMENT
-Partial tearsWell molded thumb spica cast in
slight flexion of MP jt x3-4 wks
- then , 2 weeks arom
- then 2 weeks passive rom

44. SURGICAL Tt
- Collateral lig injuries
1- Mid substance tear
2-Tear at the distal ends

45. SURGICAL Tt
- Ligament tear asso. With bony fragments
1- If fragment too small
2- if large bony fragment

46. SURGICAL Tt
- Ligament tear with osteochondral fragment
1-if Fragment very small
2-if fragment is large
3-if fixation is not possible in a fragment

47. POST OP Tt
• Removable thumb spica brace or splint x 3-
4 wks ,ROM EXERCISES
• Rmove pull out sutures& K wire 4-6 wks
• REPAIR OF OLD UCL INJURIES:
• Using EPB tendon,addr pollicis[Neviaser et
al]palmaris longus TG

48. • Avulsion #s to be treated if >25% of
articular surface involved.

51. THANK YOU