Bennett's Fracture Dislocation

ExitCare ImageBennett's fracture dislocation is named after Dr. Edward Bennett who described the condition in 1882. It is identified as a broken bone (fracture) at the base of the thumb (first metacarpal). The first metacarpal bone connects the thumb to the wrist. After the bone breaks the tendon which abducts the thumb (abductor pollicis longus) causes the two ends of the broken bone to displace (dislocate).

SYMPTOMS

  • Severe pain at the time of injury.

  • Pain and swelling at the base of the thumb.

  • Bruising (contusion) around the injured area.

  • The hand may look visibly deformed if the fracture is complete and the bone fragments separate enough to distort normal body contours.

  • Inability to grip or hold objects.

  • Numbness or paralysis from swelling in the hand, causing pressure on the blood vessels or nerves (uncommon).

CAUSES

  • Direct blow, such as a striking blow with the fist, especially if the thumb is partially flexed.

  • Indirect stress to the hand, such as that caused by twisting or violent muscle contraction (uncommon).

RISK INCREASES WITH:

  • Participation in contact sports such as football, rugby, or soccer.

  • Activities that require hitting with the hands (boxing and martial arts).

  • History of bone or joint disease, including osteoporosis.

PREVENTION

  • Maintain physical fitness.

  • Strength, flexibility, and endurance.

  • Wear protective equipment that is fitted properly.

  • Learn and use proper technique when hitting or punching.

PROGNOSIS

With appropriate treatment the likelihood of complete recovery is good. The recovery period may take 10-12 weeks.

RELATED COMPLICATIONS

  • Fracture does not heal (nonunion), or fracture heals in a bad position (malunion).

  • Chronic pain, stiffness, or weakness of the wrist.

  • Excessive bleeding in the hand, causing pressure and injury to nerves and blood vessels (rare).

  • Instability of the joint.

  • Arthritis of the joint.

  • Arrest of normal thumb growth in children.

  • Infection in open fractures (skin is broken over fracture) or at the incision or pin sites if surgery is performed.

  • Shortening of the thumb.

  • Bony prominence.

TREATMENT

Treatment varies depending on the severity of the injury.

  • If the bones are in an acceptable alignment: treatment consists of ice and elevation of the injured hand at or above the level of the heart. Pain medications may be given if necessary. The thumb should be immobilized for 4 or more weeks to allow the bones to heal.

  • If the bones are in an unacceptable alignment: treatment may consist of a closed reduction (non-surgical) or open reduction and fixation (surgical) to properly align the bones. Surgery typically involves the placement of screws and pins in the bones, which holds them together and facilitates proper healing. After reduction, the hand and wrist must be immobilized. After immobilization, stretching and strengthening exercises may be necessary. These exercises may be done with or without the assistance of a therapist.

MEDICATION

  • If pain medication is necessary, nonsteroidal anti-inflammatory medications, such as aspirin and ibuprofen, or other minor pain relievers, such as acetaminophen, are often recommended.

  • Do not take pain medication for 7 days before surgery.

  • Prescription pain relievers are usually only prescribed after surgery. Use only as directed and only as much as you need.

COLD THERAPY

Cold treatment (icing) relieves pain and reduces inflammation. Cold treatment should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain and immediately after any activity that aggravates your symptoms. Use ice packs or an ice massage.

SEEK MEDICAL CARE IF:

  • Pain, tenderness, or swelling worsens despite treatment.

  • You experience pain, numbness, or coldness in the thumb.

  • Blue, gray, or dark color appears in the fingernails.

  • Any of the following occur after surgery:

  • Fever, increased pain, swelling, redness, drainage, or bleeding in the surgical area.

  • New, unexplained symptoms develop (drugs used in treatment may produce side effects).