Bennett fracture is considered the most common fracture of the base of the thumb and belongs to the group of intraarticular fractures with displacement. It is an oblique scrape, passing through the base of the metacarpal bone. A smaller fragment of the articular surface, which, as a rule, has a triangular shape, remains in place, and the main part with the diaphysis of the bone begins to shift to the radial-back side. Bennett's fracture is also called a boxing fracture.
Causes of occurrence
The main causes of such fractures are the following situations:
- Kicking a heavy object on your wrist.
- Blow along the axis of the finger.
- Kick with your first finger bent.
- Drop on palm with outstretched arm.
- Drop resting on a finger (for example, from a bicycle).
- A hit on a hard surface (for example, when the boxers hit incorrectly).
- Strong palmar flexion of the hand.
- Sports injuries. For example, when performing gymnastic exercises.
Injury mechanism
Due to the impact directed to the axis of the thumb of the hand, the patient has a dislocation in the area of the small carpal-metacarpal joint and a fracture occurs at the base of the metacarpal bone. When a person is injured, the metacarpal bone is displaced slightly upward, as a result of which the triangular part of the ulnar edge of the base breaks off.
Symptoms
The patient immediately after Bennett’s fracture has severe pain in the hand. In the area of its dorsal surface and wrist joint, marked swelling and hemorrhage are noted. A characteristic sign of such a fracture is edema in the area of elevation of the first finger and its base. On palpation of the hand, the most severe pain occurs in areas of bone damage. When the patient attempts to Bennett fracture to produce flexion and extension, adduction and abduction of the first finger appears sharp pain. A person cannot carry out rotational movements with a brush and a finger.
Fracture of Rolando
The line of such a fracture is similar to the letter Y or T. In Rolando's fracture, fragmentation of the articular surface into 3 main parts is observed: a fragment of the body, a voluntary and dorsal fragments.
Bennett and Rolland fractures are similar. With a Rolando fracture, the diaphysis of the metacarpal bone is displaced much less, and therefore this kind of injury is not classified as traumatic fracture dislocation.
The Rolando fracture line can be observed in several projections, which affects the choice of access for surgical care, and some bone fragments can be so small that they are not visible on the x-ray.
Reasons for Rolando's fracture
Rolando's fracture is also the so-called boxing fracture. In most cases, these types of pathologies arise due to the pronounced effect on the hand along axial loads.
A boxing fracture is the result of an improperly performed (technically) blow by a specifically assembled hand: the second to fifth fingers are bent at the joints, while the thumb is bent, opposed and brought down. A fall on the radial (inner) part of the hand on the thumb brought to it can lead to a Rolando fracture. Such a pathology occurs 2 times more often than similar injuries, which are caused not by a fall, but by a shock.
Symptoms of a Rolando fracture
Signs of a Rolando fracture:
- acute pain syndrome intensifying during movements at the site of injury;
- swelling and hematoma in the elevation and base of the thumb;
- insignificant varus deformity of the first joint;
- impaired functionality of the hand - retention and grip are sharply weakened;
- the thumb is slightly bent and pressed to the hand, it cannot be taken away;
- palpation of the joint may cause a characteristic crunch;
- the load on the thumb is extremely painful.
The victim should not retract his thumb in order to recognize his injury. Such manipulation will not help to differentiate a bruise or more complex damage. If a fracture occurs, these actions can further injure soft tissues and increase the displacement of bone fragments.
Fracture of Montegi and Galeazzi
Forearm fractures with dislocations have two varieties: Galeazzi fracture and Montegi. Similar injuries occur on the radius. With a Montagei fracture, a fracture is observed in the upper part of the forearm in conjunction with a dislocation of the head. Galeazzi fracture occurs in the lower part of the forearm with dislocation of the ulna .
In the case of such fractures, the radius breaks in the lower zone. In this case, there is a dislocation in the elbow joint with a rupture of connective tissue. This is due to an indirect or direct blow to the forearm.
The causes of the above fractures are strong blows to the forearm zone.
Galeazzi fracture most often occurs in children. Injury is the result of a direct hit on the arm, and can also occur when falling on a straight arm. In this case, bone fragments move forward, and the head of the joint in the opposite direction.
Collis fracture
This type of fracture affects the distal end of the radius. The nature of the damage is very diverse (fracture without fragments, extra- and intra-articular fractures, fragmented multi-fragmented fracture). Often, such injuries are accompanied by a separation of the styloid processes in the ulna.
Collis fracture is often observed in older women. It can occur when falling on an outstretched hand, palm down. In this case, there may be no displacement, but most often the distal fragment moves to the rear-beam side. In most cases, a closed fracture is noted, however, if soft tissue is damaged, an open fracture is possible. In this case, the square pronator, the median nerve, flexor tendons, interosseous branches of the radial nerve, and the skin can be damaged.
Smith Fracture
Smith fracture belongs to the category of typical flexion fractures of the radius when the hand is bent in the opposite direction. This type of injury and its mechanism were first described by an Irish specialist in the surgical field of medicine, Robert Smith. Smith fracture with displacement is often the result of a fall on the elbow joint. Cellular fractures can be obtained in production, when working with heavy equipment, etc.
Treatment and prognosis
Several methods of neutralizing a Bennett fracture with a shift, as well as other fractures - conservative and operational. If there is no significant movement of parts of the bone during the injury, it is considered light. In this case, there is no surgical intervention, and additional manipulations are limited to plaster.
What else suggests treatment for Bennett's fracture?
If necessary, the joint is repaired and fixed in the desired position under local anesthesia.
The most favorable prognosis is the location of bone fragments at a distance of 1 to 3 mm from each other. This distance is considered to be the best for quick coalescence of fragments and restore the functioning of the brush.
If it is impossible to hold the damaged parts and maintain the functioning of the hand by external influences, surgery is used for Bennett fracture. One such method is skeletal traction.
We examined the fractures of Bennett, Collie, Smith, Galeazzi and Montagi.