Bennett's Fracture (Displaced)

ExitCare ImageA Bennett's fracture refers to a break (fracture) occurring at the base of the thumb. Displaced means the fracture has lost normal position. This often occurs when the thumb is forced backwards and towards the wrist. This fracture is easily diagnosed with X-rays. Because the fracture enters the joint between this bone and a wrist bone, it needs to be perfectly reduced and held; sometimes a good well fitting cast is enough, but often a pin may be used hold them together until they heal. There is a long-term risk of arthritis in this joint regardless of what treatment is used.

Pins used for repairing and holding in place these fractures have not been shown to change the long-term risk of arthritis of the thumb resulting from the fracture, and most surgeons would still advise their use if necessary.

TREATMENT

Hand fractures can be treated with:

  • Non-reduction - this means the fracture is casted as it is without changing the positions of the fracture (bone pieces) involved. This fracture is usually left in a cast for 4 to 6 weeks or as your caregiver thinks necessary. This also depends on your rate of healing.

  • Closed reduction, where the bones are manipulated back into position without surgery and then casted.

  • ORIF (open reduction and internal fixation) - the fracture site is opened and the bone pieces are fixed into place with some type of hardware, such as a pin, etc., and then casted.

Your caregiver will discuss the type of fracture you have and the treatment that should be best for that problem. If surgery is the treatment of choice, the following is information for you to know and also let your caregiver know about prior to surgery.

LET YOUR CAREGIVER KNOW ABOUT:

  • Allergies.

  • Medications taken including herbs, eye drops, over-the-counter medications, and creams.

  • Use of steroids (by mouth or creams).

  • Previous problems with anesthetics or numbing medication.

  • Possibility of pregnancy, if this applies.

  • History of blood clots (thrombophlebitis).

  • History of bleeding or blood problems.

  • Previous surgery.

  • Other health problems.

AFTER THE PROCEDURE

After surgery, you will be taken to the recovery area where a nurse will watch and check your progress. Once you're awake, stable, and taking fluids well, barring other problems you'll be allowed to go home. Once home an ice pack applied to your operative site may help with discomfort and keep the swelling down.

HOME CARE INSTRUCTIONS

  • Follow your caregiver's instructions as to activities, exercises, physical therapy, and driving a car.

  • Daily exercise is helpful for maintaining range of motion (movement and mobility) and strength. Exercise as instructed.

  • To lessen swelling, keep the injured hand elevated above the level of your heart as much as possible.

  • Apply ice to the injury for 15-20 minutes each hour while awake for the first 2 days. Put the ice in a plastic bag and place a thin towel between the bag of ice and your cast.

  • Move the fingers of your splinted hand several times a day.

  • If a plaster or fiberglass cast was applied:

  • Do not try to scratch the skin under the cast using a sharp or pointed object.

  • Check the skin around the cast every day. You may put lotion on red or sore areas.

  • Keep your cast dry. Your cast can be protected during bathing with a plastic bag. Do not put your cast into the water.

  • If a plaster splint was applied:

  • Wear the splint for as long as directed by your caregiver or until seen for follow-up examination.

  • Do not get your splint wet. Protect it during bathing with a plastic bag.

  • You may loosen the elastic bandage around the splint if your fingers start to get numb, tingle, get cold, or turn blue.

  • Do not put pressure on your cast or splint; this may cause it to deform. Especially, do not lean plaster casts on hard surfaces for 24 hours after application.

  • Only take over-the-counter or prescription medicines for pain, discomfort, or fever as directed by your caregiver.

SEEK MEDICAL CARE IF:

  • You have increased bleeding (more than a small spot) from beneath your cast or splint.

  • You develop redness, swelling, or increasing pain in the wound or from beneath your cast or splint.

  • There is pus coming from the wound or from beneath your cast or splint.

  • You have an unexplained oral temperature above 102° F (38.9° C).

  • A foul smell is coming from the wound or dressing or from beneath your cast or splint.

SEEK IMMEDIATE MEDICAL CARE IF:

  • You develop a rash, have difficulty breathing, or have any allergy problems.

  • Your skin or nails below the injury turn blue or gray, or feel cold or numb.

  • You develop severe pain under the cast or in your hand.

If you do not have a window in your cast for observing the wound, a discharge or minor bleeding may show up as a stain on the outside of your cast. Report these findings to your caregiver.

MAKE SURE YOU:

  • Understand these instructions.

  • Will watch your condition.

  • Will get help right away if you are not doing well or get worse.