Some authors have found no correlation between the quality of articular reduction and radiographic or subjective outcomes, while biomechanical studies have demonstrated that 2 mm of persistent articular surface step-off does not alter the contact pressures at the location of the step off. There is a debate in the literature regarding the amount of articular step-off at the fracture site that is acceptable in the nonathlete populations. The decision to treat these fractures with either open reduction or closed reduction is still a matter of debate. If it is decided to treat this fracture with open reduction, it is most commonly performed through a Wagner incision. Treating with closed reduction with intermetacarpal fixation from the first to the second metacarpal and/or to the trapezium is usually effective in reducing the first metacarpal shaft subluxation. All methods of fixation have been shown to be effective in case reviews and series. Surgical treatment of Bennett fractures is varied but generally consists of either closed reduction with percutaneous pinning or open reduction with either pins or interfragmentary screws. Historical reports have shown good outcomes with this treatment, although more recent studies have shown poor outcomes when treating these fractures with casting alone. In the initial article by Bennett, he described the treatment of these fractures with closed reduction and splinting, which remained the preferred method of treatment until the 1970s. Thumb extension (known as the hitchhiker position) has been shown to cause fracture displacement and should be avoided. Proper reduction requires traction in an axial direction with palmar abduction, and pronation while applying external pressure over the first metacarpal base. Stress radiographs can also be performed by pressing the radial aspect of the thumbs together on an AP view, which may demonstrate subluxation of the metacarpal base radially relative to the trapezium on the symptomatic side.īased upon the radiographic appearance, Gredda classified Bennett fractures into three types, with type 1 being a fracture with a single ulnar fragment and subluxation of the metacarpal base, type 2 an impaction fracture without subluxation of the first metacarpal, and type 3 an injury with a small ulnar avulsion fragment in association with metacarpal dislocation. Another view is the Bett's view, which is obtained with the palm overpronated 20 degrees from flat against the radiograph plate and the beam directed 15 degrees proximal to distal. This view is a true AP view of the first carpal-metacarpal joint it is performed with hyperpronation of the forearm having the dorsal aspect of the thumb placed against the radiographic plate and the x-ray beam directed 90 degrees to the plate. Additional dedicated views of the thumb can be obtained to provide additional information about the injury, including Robert's view. Note: We place orders with our vendors once a week, typically on Mondays.Standard hand radiographs include anteroposterior (AP), lateral, and oblique views. Once we receive your items, we will ship them to you from one of our two domestic warehouses. When orders are placed for these items, we will order them from the manufacture, and they will be included in our next incoming shipment. Requires additional information such as delivery environment and service level in order to provide an accurate shipping cost and expected date of delivery from the manufacturer.Ĭan be expected in 10-15 days. Shipping times will vary, depending on the efficiency of the individual manufacturer. We place orders with the manufacturer within a few hours of receipt of your order. We will continue to accept orders for these items and fulfill them on a first-come, first-serve basis as inventory becomes availableĭirect-Ship items are shipped directly from the manufacturer. We are not able to provide a reasonable expected date due to supply chain & other interruptions from the manufacturer. Note: All freight and handling charges are calculated on the original order.īack-orders ship and invoice separately and will not be charged additional freight and handling. Orders with both in-stock and out-of-stock items will be shipped partial, with any out-of-stock items being back-ordered and shipped complete when all back-ordered items are available. The typical wait time is just a few days. Shipment times will vary, depending on expected arrival to our inventory. Standard shipping orders received before 5pm EST will ship the same day.Įxpedited shipping orders received before 11am EST will ship the same day.
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