Surgical Management

Six weeks after injury, the patient was referred with the established diagnosis of a Bennett's fracture. Informed consent was obtained, including discussion of the risks and benefits of the various treatment options. Problems discussed included stiffness, loss of motion, pain syndromes, infection, and possible need for future surgical removal of hardware—all concepts important to the patient's profession. The patient agreed to surgical treatment.

Surgical management consisted of an attempted but unsuccessful closed reduction and percutaneous pinning. Open reduction and internal fixation with 1.0-mm Kirschner wires (K wires) was performed. Axillary block anesthesia and intravenous prophylactic antibiotics were administered. The left hand and forearm were prepped and draped, and a well-padded tourniquet was applied to the upper arm. Fluoroscopy was utilized during the procedure.

Axial traction was placed on the left thumb while simultaneously pronating, abducting, and applying pressure at the base of the first metacarpal to reduce it (Fig. 53—2). If closed reduction had been successful, a single K wire may be driven while holding the reduction from the first metacarpal into the trapezium (Fig. 53—3). Due to the elapsed time from injury, closed reduction was not successful, and therefore a lateral approach

Trapezium Reduction

Figure 53—2. The illustrations depict the manual closed reduction with traction, abduction, pronation, and compression. The fragments are held together while driving the Kirschner wire (K wire) for fixation. Note the deforming force of the abductor pollicis longus (APL) tendon.

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