A Classic Fist Fight Injury

​A right-handed man presented with swelling and tenderness at the base of his thumb after an altercation. His range of motion at the metacarpal-carpal joint was limited because of pain. Not unexpectedly, his first metacarpal was broken. What can you tell this patient about his injury?You can say:This fracture has a name: Bennett's fracture.It is the most common fracture of the base of the thumb.His fracture is classic in mechanism; fist fights commonly produce this injury (by having an axial load against a partially flexed first metacarpal).His radiographs are classic in appearance—a two-piece intraarticular fracture with an oblique fracture line. (Note that if it were in three or more pieces, it would be called a Rolando fracture.)These fractures are considered potentially unstable. The small metacarpal fragment stays attached to the trapezium through the anterior oblique ligament. The metacarpal, however, may be pulled dorsally and proximally by the abductor pollicis longus, causing subluxation or dislocation.Poorly aligned fractures can lead to instability, osteoarthritis, chronic pain, and disability.Operative management is recommended for fractures with joint instability, articular incongruence, or open fractures.Splinting in thumb extension should be avoided because this can exaggerate the displacement.Tip to Remember: Bennett's fractures need to be seen by an orthopedist or a hand surgeon in a timely manner to minimize long-term disability and pain. Ref...
Source: Lions and Tigers and Bears - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs