Bennett Fracture

What is Bennett Fracture

Bennett fracture is a break in the bone at the base of the thumb. The fracture causes that bone to separate (dislocate) from its connection to the wrist.

In some cases, the bone can be moved back into place (reduced) and then allowed to heal with a splint or a cast. However, in most cases, surgery is needed to place wires in the thumb to hold the broken pieces of bone in place while they heal.

What are the causes?

This injury may be caused by:

  • A hard, direct hit to the base of the thumb.
  • A fall.
  • Hitting something with a closed fist.

What increases the risk?

This injury is more likely to happen in people who:

  • Participate in a high-risk sport, such as wrestling, hockey, football, or skiing.
  • Have bone disease.
  • Have a lack (deficiency) of calcium.

What are the signs or symptoms?

Symptoms of a Bennett fracture develop immediately after the injury. Symptoms may include:

  • Pain, which may get worse when touching or moving the thumb.
  • Swelling and bruising at the base of the thumb.
  • Inability to move the thumb.
  • A change in how the thumb looks (deformity).
  • Coldness or numbness of the thumb.

How is this diagnosed?

This condition may be diagnosed based on:

  • Your symptoms. Your health care provider may ask about any recent thumb injuries.
  • A physical exam.
  • X-rays to confirm the diagnosis.

How is this treated?

Treatment depends on how severe the fracture is. The first step in treatment is to move the bone back into place (reduction). This may be done as:

  • Closed reduction. This is when a health care provider uses pressure and rotation to move the bone back into place by hand (manually).
    • You may have a closed reduction if your bone is only slightly out of place (is stable).
    • A closed reduction is not a surgery. It is done without cutting your skin open (without incisions).
  • Percutaneous pin fixation. This involves having a closed reduction, and then having surgery to place wires, pins, or screws over the fracture to stabilize it. This is the most common treatment.
    • You may have this done if your bone can be moved back into place but needs support while it heals.
    • This is a minimally-invasive surgery. That means that it uses incisions that are smaller than the incision(s) used in traditional (open) surgery.
  • Open reduction with internal fixation (ORIF). This is surgery to move your bones back into the right position and to place wires, pins, or screws to stabilize the fracture. This involves a larger incision.
    • You may have ORIF if your fracture is severe and very unstable.

After reduction, treatment may involve:

  • Wearing a cast or splint for several weeks.
  • Follow-up X-rays to make sure that the bone is healing well and staying in position.
  • Physical therapy to help you regain full movement and strength in your hand.

Follow these instructions at home:

If you have a splint:

  • Do notput pressure on any part of the splint until it is fully hardened. This may take several hours.
  • Wear the splint as told by your health care provider. Remove it only as told by your health care provider.
  • Ask your health care provider if you may remove the splint for bathing. If you must keep the splint on at all times, and it is not waterproof:
    • Cover it with a watertight covering when you take a bath or a shower.
    • Do notlet the splint get wet.
  • Loosen the splint if your thumb or fingers tingle, become numb, or turn cold and blue.
  • Keep the splint clean.

If you have a cast:

  • Do notput pressure on any part of the cast until it is fully hardened. This may take several hours.
  • Do notstick anything inside the cast to scratch your skin. Doing that increases your risk of infection.
  • Check the skin around the cast every day. Tell your health care provider about any concerns.
  • You may put lotion on dry skin around the edges of the cast. Do notput lotion on the skin underneath the cast.
  • Keep the cast clean.
  • If your cast is not waterproof:
    • Cover it with a watertight covering when you take a bath or a shower.
    • Do not let the cast get wet.

Managing pain, stiffness, and swelling

  • If directed, put ice on the injured area.
    • If you have a removable splint, remove it only as told by your health care provider.
    • Put ice in a plastic bag.
    • Place a towel between your skin and the bag or between your cast and the bag.
    • Leave the ice on for 20 minutes, 2–3 times a day.
  • Move your fingers often to avoid stiffness and to lessen swelling.

Raise (elevate) your hand above the level of your heart while you are sitting or lying down.

Driving

  • Do notdrive or use heavy machinery while taking prescription pain medicine.
  • Ask your health care provider when it is safe to drive if you have a cast or splint on your hand.

Activity

  • Return to your normal activities as directed by your health care provider. Ask your health care provider what activities are safe for you.
  • If physical therapy was prescribed, do exercises as directed.

General instructions

  • Do notuse any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. These can delay bone healing. If you need help quitting, ask your health care provider.
  • Take over-the-counter and prescription medicines only as told by your health care provider.
  • Keep all follow-up visits as told by your health care provider. This is important. You may need follow-up X-rays.

Contact a health care provider if:

  • You have pain that gets worse.
  • You have a fever.

Get help right away if:

  • You develop a rash.
  • You have severe pain.
  • You have trouble breathing.
  • The skin or fingernails of your affected hand turn blue even after loosening your splint, if applicable.
  • Your hand feels cold or numb even after loosening your splint, if applicable.

Summary

  • A Bennett fracture is a break in the bone at the base of the thumb. It causes that bone to separate (dislocate) from its connection to the wrist.
  • In some cases, the bone can be moved back into place (reduced) and then allowed to heal with a splint or a cast. However, in most cases, surgery is needed to place wires to hold the broken pieces of bone in place while they heal.
  • Ask your health care provider when it is safe to drive if you have a cast or splint on your hand.

Bennett Fracture Treated With ORIF

A Bennett fracture is a break (fracture) in the bone at the base of your thumb. This injury causes the bone at the base of your thumb to separate (dislocate) from its connection to your wrist. This type of fracture often happens when the thumb is forced back toward the wrist. It can also happen from a hard, direct hit to the thumb.

Open reduction with internal fixation (ORIF) is one type of surgery that is used to repair the fracture and keep the bones stable. During ORIF, a surgeon makes an incision over the fracture and uses surgical pins or wires to hold the bones in place.

Tell a health care provider about:

  • Any allergies you have.
  • All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
  • Any problems you or family members have had with anesthetic medicines.
  • Any blood disorders you have.
  • Any surgeries you have had.
  • Any medical conditions you have.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

  • Infection.
  • Failure of the fracture to heal.
  • Long-term pain and stiffness (arthritis).

What happens before the procedure?

  • Ask your health care provider about:
    • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
    • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood.Do nottake these medicines before your procedure if your health care provider instructs you not to.
  • Follow your health care provider’s instructions about eating or drinking restrictions.
  • Plan to have someone take you home after the procedure.
  • If you go home right after the procedure, plan to have someone with you for 24 hours.

What happens during the procedure?

  • An IV tube may be inserted into one of your veins.
  • You will be given one or more of the following:
    • A medicine that helps you relax (sedative).
    • A medicine that numbs the area (local anesthetic).
    • A medicine that makes you fall asleep (general anesthetic).
  • The skin over your hand and arm will be cleaned with a germ-killing solution (antiseptic).
  • The surgeon will make an incision through your skin to expose the areas of the fracture.
  • The broken bones will be put back into their normal positions. To hold the bones in place, the surgeon will use different types of wiring or a combination of screws and a metal plate.
  • X-rays may be taken to make sure that the bones are in the correct position.
  • After the bones are back in place, the incision will be closed with stitches (sutures) or staples.
  • A bandage (dressing) will be placed to cover the incision.
  • A cast or splint will be placed over your wrist.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

  • Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored often until the medicines you were given have worn off.
  • You will be given pain medicine as needed.

Care After Bennett Fracture Treated With ORIF

What can I expect after the procedure?

After the procedure, it is common to have:

·         Pain.

·         Swelling.

Follow these instructions at home:

If you have a cast:

·         Do notstick anything inside the cast to scratch your skin. Doing that increases your risk of infection.

·         Check the skin around the cast every day. Report any concerns to your health care provider. You may put lotion on dry skin around the edges of the cast. Do notapply lotion to the skin underneath the cast.

If you have a splint:

·         Wear it as directed by your health care provider. Remove it only as directed by your health care provider.

·         Loosen the splint if your fingers become numb and tingle, or if they turn cold and blue.

Bathing

·         Cover the cast or splint with a watertight plastic bag to protect it from water while you take a bath or a shower. Do notlet the cast or splint get wet.

Incision care

·         There are many different ways to close and cover an incision, including stitches, skin glue, and adhesive strips. Follow your health care provider’s instructions about:

o    Incision care.

o    Bandage (dressing) changes and removal.

o    Incision closure removal.

·         Check your incision area every day for signs of infection. Watch for:

o    Redness, swelling, or pain.

o    Fluid, blood, or pus.

Managing pain, stiffness, and swelling

·         If directed, apply ice to the injured area (if you have a splint, not a cast):

o    Put ice in a plastic bag.

o    Place a towel between your skin and the bag.

o    Leave the ice on for 20 minutes, 2–3 times per day.

·         Move your fingers often to avoid stiffness and to lessen swelling.

·         Raise the injured area above the level of your heart while you are sitting or lying down.

Driving

·         Do notdrive or operate heavy machinery while taking pain medicine.

·         Do notdrive while wearing a cast or splint on a hand or foot that you use for driving.

Activity

·         Return to your normal activities as directed by your health care provider. Ask your health care provider what activities are safe for you.

·         Perform exercises daily as directed by your health care provider or physical therapist.

Safety

·         Do notuse your injured limb to support any part of your body weight until your health care provider says that you can.

General instructions

·         Do notput pressure on any part of the cast or splint until it is fully hardened. This may take several hours.

·         Keep the cast or splint clean and dry.

·         Do notuse any tobacco products, including cigarettes, chewing tobacco, or electronic cigarettes. Tobacco can delay bone healing. If you need help quitting, ask your health care provider.

·         Take medicines only as directed by your health care provider.

·         Keep all follow-up visits as directed by your health care provider. This is important.

Contact a health care provider if:

·         Your pain is getting worse.

·         You have redness, swelling, or pain in your incision area.

·         You have fluid, blood, or pus coming from under your cast or splint.

·         You notice a bad smell coming from under your cast or splint.

·         You have a fever.

Get help right away if:

·         You develop a rash.

·         You have difficulty breathing.

·         The skin or nails on your injured hand turn blue or gray even after you loosen your splint.

·         Your injured hand tingles, feels cold, or becomes numb even after you loosen your splint.

·         You develop severe pain under the cast or in your hand.

 

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