Diagnosis

Bennett's Fracture Dislocation

The diagnosis was a Bennett's fracture and intraarticular fracture of the first metacarpal bone with two fragments; the larger fragment shows subluxation from the deforming pull of the abductor pollicis longus tendon.

The Bennett's fracture is the most common intraarticular injury involving the carpometacarpal joint of the thumb. Because the abductor pollicis longus tendon acts as a deforming force, stabilization by fixation is necessary. An attempt at closed reduction is recommended by applying traction to the thumb metacarpal with radial abduction and a pronation rotatory torque. A wire is percutaneously driven while holding the thumb in palmar abduction and opposition if reduction is achieved. The pin may be driven into the index metacarpal or trapezium. Always strive for anatomic reduction. However, acceptance of a 2-mm or less articular stepoff does not biomechanically predispose a patient to posttraumatic osteoarthritis if the fragments heal in close apposition. The priority of treatment should be reduction of the metacarpal shaft relative to the trapezium and small fragment.

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