Little evidence for conservative or operative management of undisplaced Bennett’s fractures
Date First Published:
March 1, 2000
Last Updated:
May 24, 2001
Report by:
Bruce Martin, Clinical Fellow (Manchester Royal Infirmary)
Search checked by:
Martin Smith, Manchester Royal Infirmary
Three-Part Question:
In [an adult patient with an undisplaced Bennetts' fracture] is [conservative management better than surgical management] at [minimising time to recovery and final disability]?
Clinical Scenario:
A 32 year old man presents to the Emergency Department following a fight. He complains of pain around the base of the right thumb metacarpal. X-ray reveals an undisplaced Bennetts' fracture. You wonder whether he should be treated conservatively or surgically.
Search Strategy:
Medline 1966-10/99 using the OVID interface.
Search Details:
[{exp fractures OR exp fractures, closed OR fracture$.mp} AND [({exp thumb OR thumb.mp OR first.mp} AND {exp metacarpus OR metacarp$.mp}) OR Bennett$] AND {exp emergency treatment OR exp treatment outcome OR treatment$.mp OR treat$.mp}] LIMIT to human AND english.
Outcome:
98 papers found of which 92 irrelevant or of insufficient quality for inclusion. The remaining six papers are shown in the table.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Fractures of the base of the first metacarpal bone: results of surgical treatment. van Niekerk JL and Ouwens R. 1989, Netherlands | 12 of 23 patients with fractures at the base of the thumb metacarpal treated surgically | Retrospective survey | Limitation of activities of daily living | No limitations | Small numbers Uncontrolled |
| Bennett's fracture. Kjaer-Petersen K, Langhoff O, Andersen K. 1990, Denmark | 41 patients with Bennett's fracture treated variously (9 closed reduction, 6 percutaneous K wires, 26 open reduction). Followed up at a median of 7.3 years. |
Retrospective survey | Residual symptoms | No symptoms in 15 of 18 with good reductions compared with 6 of 13 with residual displacement. | |
| The conservative management of Bennett's fracture-dislocation: a 26-year follow-up. Livesley PJ. 1990, UK | 17 patients with Bennett's fracture treated conservatively Followed up at a mean of 26 years. |
Retrospective survey | Residual symptoms | 7 of 17 | Small numbers Uncontrolled |
| Range of movement and grip strength | Reduced in all patients | ||||
| Bennett's fracture: a medium to long-term review. Aust New Zealand Thurston AJ and Dempsey SM. 1993, New Zealand | 21 of 76 patients with Bennett's fracture Followed up at a mean of 7 years 7 months |
Retropective survey | Residual symptoms | Less if residual fracture displacement less than 1mm. Method of reduction immaterial | Small numbers |
| long-term evaluation of Bennett's fracture. A comparison between open and closed reduction. Timmenga EJ, Blokhuis TJ, Maas M et al. 1994, Netherlands | 18 patients with Bennett's fracture. Closed reduction with K wire fixation (7) vs open reduction and bone graft (11) Followed up at a mean of 10.7 years |
Retropective survey | Thumb mobility | Full in all cases | Small numbers |
| Grip strength | Reduced in all cases | ||||
| Osteoarthritis | Degree correlated with the residual displacement | ||||
| Nonoperative treatment of Bennett's fracture: a 13 year follow-up. Oosterbos CJ and de Boer HH. 1995, Netherlands | 20 of 22 patients with Bennett's fracture treated by closed reduction and plaster immobilisation. | Retrospective survey | Subjective outcome | Satisfactory in 18 of 20 | Small numbers Uncontrolled |
| Development of arthrosis | 7 of 20. in 6 of these original reduction had been nonanatomic |
Author Commentary:
The evidence in this area is extremely poor. All studies are small and retrospective. A well designed PRCT is needed.
Bottom Line:
Good initial reduction probably reduces the incidence of later arthrosis of the base of the thumb metacarpal. There is no evidence to help decide whether a conservative or a surgical approach is preferable.
References:
- van Niekerk JL and Ouwens R.. Fractures of the base of the first metacarpal bone: results of surgical treatment.
- Kjaer-Petersen K, Langhoff O, Andersen K.. Bennett's fracture.
- Livesley PJ.. The conservative management of Bennett's fracture-dislocation: a 26-year follow-up.
- Thurston AJ and Dempsey SM.. Bennett's fracture: a medium to long-term review. Aust New Zealand
- Timmenga EJ, Blokhuis TJ, Maas M et al.. long-term evaluation of Bennett's fracture. A comparison between open and closed reduction.
- Oosterbos CJ and de Boer HH.. Nonoperative treatment of Bennett's fracture: a 13 year follow-up.