Accuracy of fluoroscopic examination in the treatment of Bennett’s fracture

Background Restoration of joint congruity is an important factor for the prevention of subsequent arthritis in patients with Bennett’s fracture. Surgical treatment of Bennett’s fracture is thus generally recommended for displaced intra-articular fractures to the proximal aspect of the thumb metacarpal. Fluoroscopic examination is used to evaluate the adequacy of closed reduction after pinning of Bennett’s fracture. The purpose of this study was to determine the accuracy of fluoroscopy to determine the reduction of Bennett’s fractures. Methods A model was created, to mimic a Bennett’s fracture utilizing ten fresh-frozen cadaveric hands. An oblique cut was made in the proximal aspect of the thumb metacarpal using an oscillating saw. The small oblique fragment involved 1/4–1/3 of the joint surface was then shifted in position creating a step-off or gap at the fracture site. An anatomical reduction model, gap models (1 mm, 2 mm, 3 mm), and step-off models (1 mm, 2 mm, 3 mm) were created using percutaneous fixation with two 1.0 mm Kirschner wires for each cadaveric hand. Fluoroscopic assessment then took place and was reviewed by 2 attending hand surgeons blinded to the actual position. Their estimated fluoroscopic position was then compared to the actual displacement. Results The step-off and gap on fluoroscopic examination showed a significant difference compared to the step-off and gap from direct visualization. The frequency of underestimation for the 3 mm displacement models from the fluoroscopic examination was 60%. The frequency for overestimated was 9% for the models in which displacement was within 2 mm (0, 1, 2 mm). Conclusions The assessment of articular gap and step-off using PA (postero-anterior), AP (antero-posterior), and lateral view of fluoroscopic examination is not accurate as compared to the examination by direct visualization. Surgeons need to be aware that PA, AP and lateral view of fluoroscopic examination alone may not be sufficient to judge the final position of a reduced Bennett’s fracture. Other methods such as live fluoroscopy in multiple different planes, 3-dimensional fluoroscopy or arthroscopic examination should be considered.

Bennett’s Fracture Repair—Which Method Results in the Best Functional Outcome? A Retrospective Cohort Analysis and Systematic Literature Review of Patient-Reported Functional Outcomes

Surgical fixation of Bennett’s fracture of the thumb is critical to prevent functional impairment; however, there is no consensus on the optimal fixation method. We performed an 11-year retrospective cohort analysis and a systematic literature review to determine long-term patient-reported outcomes following Bennett’s fracture fixation. Retrospective cohort analysis identified 49 patients treated with Kirschner (K)-wire fixation, 85% returned to unrestricted movement during hand therapy. Forty-seven patients (96%) completed the disabilities of the arm, shoulder, and hand (DASH) questionnaires at a mean of 5.55 years from injury, with a mean score of 7.75. Systematic literature review identified 14 studies with a cumulative 541 patients. Fixation included open or percutaneous methods utilizing K-wires, tension band wiring, lag screws, T-Plates, external fixation, and arthroscopic screw fixation. Functional outcomes reported included DASH, quickDASH (qDASH), and visual analogue scores. Superficial wound infection occurred in 4 to 8% of percutaneous K-wire fixation. Open reduction internal fixation (ORIF) methods were associated with a 4 to 20% rate of reintervention and 5 to 28% rate of persistent paresthesia. Closed reduction with percutaneous K-wire fixation should be the first choice surgical method, given excellent, long-term functional outcomes, and low risk of complications. ORIF should be utilized where closed reduction is not achievable; however, the current evidence does not support one method of ORIF above another.

A case report on the effect of Cissus quadrangularis on fracture union in 26 years aged man

<p class="abstract">Ayurveda the ancient science of medicine describes various herb preparations that achieve the hastening of bone healing<em>. Cissus quadrangularis Linn</em>. is an indigenous medicinal plant which belongs to a family of Vitaceae. A case study was undertaken to evaluate the fracture union and effectiveness in reduction of pain and swelling in a 26 year old male with Bennett’s fracture. A quick union of fracture was observed within 6 weeks of treatment with <em>C. quadrangularis</em>. Post treatment radiographic reports showed united fracture with good amount of callus.</p>

Bone and joint injuries of the hand

The small bones and joints of the hand are vulnerable to fracture and dislocation. These same structures need to be pain-free, stable, and mobile for proper function. Careful diagnosis and meticulous management is required. This may entail early mobilization (e.g. a metacarpal neck fracture) or temporary splinting (e.g. mallet fracture), early repair (e.g. unstable thumb ulnar collateral avulsion), complex sequential and dynamic splinting (e.g. central slip rupture); percutaneous wires (e.g. Bennett’s fracture) or plate fixation (e.g. displaced index metacarpal shaft). There is often a trade-off between the mobilization required to avoid stiffness and the immobilization required to allow anatomical healing. Rigid surgical fixation with meticulous hand therapy may both contribute in certain patients.

ARTHROSCOPIC ASSISTED PERCUTANEOUS SCREW FIXATION OF BENNETT'S FRACTURE

Several techniques are used for fixation of Bennett's fractures. The aim of this study was to assess a technique of arthroscopic-assisted reduction and percutaneous cannulated screw fixation of Bennett's fractures. Seven patients (mean age 29 years) with three fractures Type I and four fractures Type II according to Gedda were operated under arthroscopic lavage, fluoroscopic screw fixation, and arthroscopic control of the joint reduction. Arthroscopy, showed satisfactory joint reduction in all cases. At 4.5 months, the mean pain score was 1 (0–4), QuickDASH 15 (0–61), and Kapandji score 9 (5–10). Compared to the contralateral side, first web opening was 86% (58–100), key pinch 73% (45–89), grip strength, and 85% (40–100). Four secondary displacements were noted, two of which had a step of more than 1 mm. Our results showed that the use of arthroscopy for percutaneous screw fixation of Bennett's fractures facilitates joint reduction but does not guarantee stability of fixation.