Traditional medicine

Fracture of the 3rd metacarpal bone of the hand. Metacarpal fractures in children

Bennett's fracture is one of the most famous fractures. It occurs in the first metacarpal bone. It was described by the famous surgeon Edward Bennett at the beginning of the nineteenth century. But this type of fracture can most likely be called Bennett’s fracture-dislocation.

The first metacarpal bone is located separately from the other bones of the hand. It is more mobile and its functionality is equivalent to the other four bones. During an injury, the part of the bone that is closer to the wrist area remains in its original position.

At the same time, the rest of it, as well as the nearby joint, moves significantly outward. This happens because the bone on the path of displacement does not encounter any resistance, and the long muscle that abducts the thumb, on the contrary, contributes to such displacement. Such a displacement resembles a subluxation of the metacarpal bone in relation to the large bone, which has the shape of a trapezoid.

Symptoms of injury are pronounced. A person is worried about a strong pain sensation, and when moving the hand, these sensations only intensify. The arm feels weak and stops functioning. In the area of the fracture, swelling and a clearly defined bruise appear, and the thumb becomes deformed.

You should not diagnose a fracture by palpation, as this will only cause more suffering to the patient. A fracture can only be determined using radiography.

Reasons

This type of fracture occurs when the blow falls on the axis of the finger. At this time, dislocation of the carpometrial joint occurs. Along with this, a bone fracture occurs as it moves upward and in the process, part of the bone breaks off.

If a fracture occurs, it is unnecessary to use independent treatment, as this can significantly worsen the situation. After such attempts, a traction method of reduction is used. The best way to treat Bennett's fracture is to consult a specialist.

Education mechanism

The injury occurs because the thumb bone is in opposition to the other bones. This can happen when the fist hits a hard surface. Such injuries most often occur in the following situations:

during a fight between two boxers;
during a fall, when the blow falls on the hand, especially the thumb;
in the case when a person falls from a bicycle and throws his arm forward for support or holds the handlebars in a way that promotes a fracture.

In these cases, a bone fracture occurs. Trauma is treated in two ways. In the first case, under anesthesia, the broken bone is set and a plaster cast is applied. In the second, surgical intervention is used.

Bennett's fracture is considered the most common fracture of the base of the thumb and belongs to the displaced group. It is an oblique fracture 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 dorsal side. Bennett's fracture is also called a boxer's fracture.

Causes

The main causes of such fractures are the following situations:

Hitting the wrist with a heavy object.
Impact on the axis of the finger.
Strike with the bent first finger.
Falling onto the palm with an outstretched arm.
Falling on a finger (for example, from a bicycle).
Hitting a hard surface (for example, with illegal punches in boxers).
Strong palmar flexion of the hand.
Sports injuries. For example, when performing gymnastic exercises.

Mechanism of injury

Due to a blow directed at the axis of the thumb, the patient experiences a dislocation in the area of the small carpometacarpal joint and a fracture occurs at the base of the metacarpal bone. When a person is injured, the metacarpal bone shifts slightly upward, as a result of which the triangular part of the ulnar edge of the base breaks off.

Symptoms

A patient immediately after a Bennett fracture experiences severe pain in the hand. In the area of its dorsal surface and wrist joint there is marked swelling and hemorrhage. A characteristic sign of such a fracture is swelling in the area of the eminence of the first finger and its base. When palpating the hand, it occurs in areas of bone damage. When a patient with a Bennett fracture tries to flex and extend, adduct and abduct the first finger, sharp pain appears. A person cannot perform rotational movements with the hand and finger.

Rolando's fracture

The line of such a fracture is similar to the letter Y or T. With a Rolando fracture, fragmentation of the articular surface into 3 main parts is observed: a fragment of the body, volar and dorsal fragments.

Bennett and Rolland fractures are similar. With a Rolando fracture, the diaphysis is displaced significantly less, and therefore this type of injury does not belong to the category of traumatic fracture-dislocations.

Rolando's fracture line can be observed in several projections, which influences the choice of surgical approach, and some bone fragments may be so small that they are not visible on an x-ray.

Reasons for getting a Rolando fracture

Rolando's fracture dislocation is also a so-called boxer's fracture. In most cases, these types of pathologies arise due to a pronounced impact on the hand due to axial loads.

A boxing fracture is a consequence of an incorrectly executed (technically) blow with a specifically assembled hand: the second to fifth fingers are bent at the joints, while the thumb is bent, opposed and adducted. A fall on the radial (inner) part of the hand on the adducted thumb can lead to a Rolando fracture. This pathology occurs 2 times more often than similar injuries that are caused not by a fall, but by an impact.

Symptoms of a Rolando fracture

Signs of a Rolando fracture:

Acute pain in the area of injury that intensifies with movement;
swelling and hematoma in the eminence and base of the thumb;
minor varus deformity of the first joint;
impaired functionality of the hand - sharply weakened retention and grip;
the thumb is slightly bent and pressed against the hand, it cannot be moved away;
When palpating the joint, a characteristic crunch is possible;
putting pressure on the thumb is extremely painful.

The victim should not move his thumb away in order to recognize his injury. Such manipulation will not help differentiate between a bruise and a more complex injury. If a fracture occurs, these actions can further injure soft tissues and increase the amount of displacement of bone fragments.

Monteggia and Galeazzi fracture

In such fractures, the radius bone breaks in the lower zone. In this case, there is a dislocation in the area of the elbow joint with rupture of the connective tissue. This is observed due to an indirect or direct blow to the forearm.

The causes of the above fractures are strong blows to the forearm area.

Galeazzi's fracture most often occurs in children. The injury is a consequence of a direct blow to the arm, and can also occur when falling on a straight arm. In such a case, the bone fragments move forward, and the head of the joint moves 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, comminuted multi-fragmented fracture). Often such injuries are accompanied by separation of the styloid processes in the ulna.

A Collis fracture is often seen in older women. It can occur when falling on an outstretched arm with the palm facing down. There may not be any displacement, but most often the distal fragment moves to the dorsoradial side. In most cases, a closed fracture is observed, however, if soft tissue is damaged, an open one is possible. In this case, the pronator quadratus, median nerve, flexor tendons, interosseous branches of the radial nerve, and skin can be damaged.

Smith's fracture

Smith's fracture falls into 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 the Irish specialist in surgical medicine, Robert Smith. A displaced Smith fracture is often the result of a fall on the elbow. Comminuted fractures can occur at work, when working with heavy equipment, etc.

Treatment and prognosis

Several methods are proposed to neutralize the displaced Bennett fracture, as well as other fractures - conservative and operative. If the injury does not cause significant movement of parts of the bone, it is considered mild. In this case, surgical interventions are avoided, and additional manipulations are limited to plaster.

What else does treatment for Bennett's fracture involve?

If necessary, the joint is realigned and fixed in the desired position under local anesthesia.

The most favorable prognosis is considered to be the location of bone fragments at a distance of 1 to 3 mm from each other. This distance is considered the best for rapid fusion of fragments and restoration of hand function.

If it is impossible to hold the damaged parts and maintain the functioning of the arm by external influences, surgery is used for Bennett's fracture. One such method is skeletal traction.

We looked at the Bennett, Colley, Smith, Galeazzi, and Monteggia fractures.

A Bennett fracture (dislocation fracture of the first metacarpal) is a type of bone injury often seen in people who participate in sports (particularly boxers). This type of injury was first described in his work by surgical professor Edward Bennett in 1882.

Reasons

A blow to the wrist with a heavy object;
Impact on the axis of the first finger;
Strike with the first finger of the hand bent and extended;
Fall onto the palm with an outstretched hand;
Falling on the thumb (for example, falling from a bicycle);
Hitting a hard surface with a fist (in case of an incorrect blow for boxers);
Excessive palmar flexion of the hand;
Sports injury (eg gymnastics).

Mechanism of injury

As a result of a blow aimed at the axis of the first finger of the hand, the victim experiences a dislocation in the area of the small carpometacarpal joint and at the same time a fracture occurs at the base of the first metacarpal bone. When a person is injured, the metacarpal bone moves slightly upward and, as a result, breaks off the triangular part of the ulnar edge of its base.

Symptoms

The victim immediately after the injury experiences pain in the hand;
The patient has swelling and hemorrhages in the area of the dorsal surface of the hand and in the area of the wrist joint;
A characteristic symptom is swelling in the area of the base and eminence of the first finger;
When palpating the hand, maximum pain occurs in the area of bone damage;
When the patient tries to flex and extend, abduct and adduct the first finger, sharp pain occurs;
A person cannot make rotational movements with his finger and hand;
When examining the patient’s hand, you can see that the first finger of the hand is adducted, and a bony protrusion can be identified in the area of the base of the first metacarpal bone;
The victim experiences sharp pain on palpation along the main axis of the extended finger;
As a result of injury, a person’s wrist joint is deformed (on the radial side);
With a Bennett fracture, the contours of the anatomical snuffbox are smoothed out in the victim;
Upon palpation in the area of the injured finger, crepitus of bone fragments can be determined;
The axial load on the injured first finger of the hand is very painful;

Diagnostics

When examining a patient, the doctor should not check for all the reliable signs of a Bennett's fracture, since they cause very severe pain in the patient.

X-ray examination of the thumb in two projections helps confirm the diagnosis.

Treatment

There are two types of treatment for Bennett's fracture:

Conservative;
Operational.

Conservative treatment of Bennett's fracture

If the victim has a fracture and slight displacement of the fragments (no more than 1 mm), then a plaster or polymer bandage is applied for 1 month. It is also necessary to take a control x-ray after 5-7 days.

Closed reduction of bone fragments is carried out under local anesthesia. The traumatologist injects a 2% solution of procaine or a 1% solution of novocaine in a volume of 5-10 ml into the area of the first carpometacarpal joint. The doctor's assistant stretches the first finger lengthwise with one hand and at the same time pulls fingers 2-5 with the other hand. At this time, the traumatologist places the bandage in the area of the first interdigital space and, using traction on the bandage, creates countertraction. The process of such traction itself takes on average 5-7 minutes.

After this manipulation, the first finger of the patient’s hand is placed in the position of maximum abduction and a circular plaster bandage is applied. It fixes not only the first finger of the hand, but also reaches the upper third of the forearm. After applying the plaster, the patient is given a control x-ray.

According to many traumatologists, the distances between bone fragments should not exceed 1-3 mm. If after reposition the bone fragments are in good condition, then the immobilizing plaster bandage is removed after 1 month.

In some victims, bone fragments are aligned, but it is very difficult to keep them in the correct position. In this case, surgical treatment is indicated.

Surgery for Bennett's fracture

Methods

Skeletal traction (you can read about methods of skeletal traction);
Fixation with Kirschner wires and bone autospike.

In many manuals on traumatology, the method of treating a Bennett fracture using skeletal traction is described as unreliable, since in this case repeated displacement of bone fragments occurs very often, and attempts to increase traction do not lead to positive results. The design on the hand is usually fixed with a plaster cast and its stability cannot be considered good. If the rod is installed behind a metal pin passed through the thumb, then this quite often leads to infection of the soft tissues and hand, because the pin periodically moves.

The patient's ability to work with a Bennett fracture is usually restored after

A Bennett fracture is a fracture of the base of the thumb. This intra-articular fracture is the most common type of injury to the thumb and is almost always accompanied by some degree of subluxation or obvious deformity of the joint. Named after the surgeon who described it in 1882, Irishman Edward Bennett. For Bennett's fracture, self-treatment at home is unacceptable, because this can lead to negative consequences. It is recommended to consult a doctor immediately.

Bennett's fracture with displacement

The first metacarpal bone is located separately from the other bones of the hand. It has greater mobility and is equivalent in functionality to the other four bones. During an injury, the part of the bone closest to the wrist remains in its original position. At the same time, the rest of it, as well as the nearby joint, moves significantly outward. This happens due to the fact that the bone on the path of displacement does not encounter any resistance, and the long muscle that abducts the thumb, on the contrary, contributes to this displacement.

Causes of Bennett's fracture

A Bennett fracture occurs when there is a blow to the axis of the finger. The force causes dislocation of the carpometacarpal joint, and part of the bone breaks off.

The main causes of Bennett's fracture include:

a strong blow to the wrist;
strike with a bent thumb;
falling and landing on your outstretched thumb.

Bennett's fracture symptoms

Immediately after the injury, the victim experiences severe pain at the base of the thumb. Severe swelling and subcutaneous hemorrhage occur on the dorsum of the hand and in the area of the wrist joint. The most characteristic symptom of a Bennett fracture is obvious swelling in the area of the eminence of the thumb and its base. At the same time, a displaced Bennett fracture is characterized by visible deformation.

When palpating the hand, the most severe pain occurs at the site of direct violation of the integrity of the bone. Also, Bennett's fracture is accompanied by severe pain when flexing/extending, adducting/abducting the thumb. The victim cannot make rotational movements with the hand and fingers.

Diagnosis of Bennett's fracture

Primary diagnosis is based on clarifying the circumstances of the injury and its mechanism - a fall, blow, etc. By touch, a specialist can easily determine the displacement of the edge of the first metacarpal bone. In the same place there is severe pain. Lightly tapping the tip of the thumb causes pain. The patient also experiences pain when palpating the metacarpal joint on the palm side. A prerequisite for making a diagnosis is an x-ray examination. The most accurate picture is shown by radiography in two projections.

Conservative treatment of Bennett's fracture

Bennett's fracture is treated in two ways: conservative and surgical. If the fracture is accompanied by a slight displacement of the fragments, i.e. up to 1 mm, then a plaster cast is applied to the hand for a period of 4 weeks. A week after the cast is applied, the doctor will order a repeat x-ray to make sure the bones are healing properly.

If the fracture has caused a more serious displacement of the fragments, then closed reduction is performed. The procedure for comparing bone fragments is carried out under local anesthesia. The doctor's assistant stretches the first finger lengthwise with one hand and at the same time with the other hand pulls in the direction of the remaining fingers. At this time, the doctor places a bandage in the area of the first interdigital space and, using traction on the bandage, creates countertraction. The process of such reposition itself lasts no more than 7 minutes.

After reposition, the victim’s thumb is fixed in the position of maximum abduction, and a circular plaster bandage is applied. The victim is then sent for a repeat x-ray to check the position of the bones. According to traumatologists, the distances between bone fragments should be no more than 3 mm. It is this distance that promotes good fusion of bones, affects the preservation of joint stability and restoration of the physiological function of the hand. Neglect of these principles is fraught with the development of arthrosis and associated negative consequences.

If proper fusion of bone fragments is observed after reposition, the plaster bandage is removed after 4 weeks. With a Bennett fracture, restoration of the injured arm’s ability to work should be expected no earlier than after 1.5-2 months. There are often cases when bone fragments are juxtaposed in victims, but it is impossible to hold them in the desired position with just a bandage. In such situations, surgical intervention is prescribed.

Surgical treatment of Bennett's fracture

If the victim arrives with an open fracture, then the first procedure is to clean the open wound from dirt and bone fragments, after which they proceed directly to surgery. Surgery for Bennett's fracture involves matching and repositioning bone fragments, for which a pin is inserted to fix them. The end of the needle is left above the surface of the skin. After this, the incision is sutured and a tight plaster bandage is applied.

As the bones heal, your doctor may order one to four x-rays. This need is determined by the nature of the fracture, the immediate course of the operation, and the percentage of wrist deformity. If healing is successful, after three weeks the pin is removed, and a plaster cast fixes the bones for another three weeks.

Rehabilitation after Bennett's fracture

Immobilization of the hand after a Bennett fracture lasts an average of one month. Then the doctor prescribes massage, therapeutic baths, and exercises to help return the injured limb to functionality. With proper rehabilitation, working capacity returns in 1-1.5 months. Incorrect treatment and unscrupulous compliance with rehabilitation measures are fraught with the development of deforming arthrosis and a sharp decrease in the performance of the hand.

Rehabilitation consists of:

physical therapy - a set of special exercises, including, in particular, work on simulators and expanders;
physiotherapeutic procedures - electrophoresis, warm paraffin applications, therapeutic mud or clay;
course of therapeutic and restorative massage.

It is not recommended to ignore the instructions of the attending physician and the recommendations of the rehabilitation physician. It is also worth noting that, depending on the nature of the injury and the healing process, the specialist will draw up an individual rehabilitation plan, conscientious adherence to which will guarantee a speedy restoration of hand function. If you neglect rehabilitation measures, complications will inevitably arise - stiffness, arthrosis or non-union of bones. The listed complications are accompanied by severe pain and can reduce the functional ability of the hand by up to 50%. Elimination of such consequences will require special treatment, including arthroplasty, the cost of which is quite high.

Conclusion

In most cases, the cause of a Bennett fracture is mechanical damage to the axis of the thumb. A fracture is characterized by pain at the base of the thumb, severe pain when touched, and the inability to retract the finger. The method of treatment and its duration depend on how the bone fragments are located and how the process of their fusion proceeds. Treatment of a Bennett fracture can be considered successful if the functionality of the finger and hand is completely restored. It is very important to pay close attention to rehabilitation. It depends on how quickly and to what extent performance is restored. On average, recovery takes up to two months.

A fracture of the metacarpal bone is one of the common injuries of the hand, in which the tubular bone located on the hand in the hand is damaged. There are 5 such tubular bones: starting with the big bone and ending with the little finger. When the metacarpal bone is injured, its integrity is damaged. Typically, deformation occurs after direct and strong impact on the hand.

A fracture of the metacarpal bone is popularly referred to as a “brawler’s fracture.”

Classification

Diagnosis of a metacarpal fracture includes classification according to several positions:

Nature of damage:

Open – the skin is damaged, the fragment is visible from the outside.
Closed - the fragment is not visible, the skin is not injured.
Splintered injuries are the most dangerous type of injury; they can be open or closed. There are multiple injuries, often with fragments and disruption of the integrity of the skin.

Number of injured areas:

Single – no more than one bone injury recorded.
Multiple – several fragments are present.

Shape and direction of deformed bone:

Oblique.
Angular.
Rotary.
Helical.

According to the nature of the location of bone fragments:

Displaced fracture.
No offset.

At the location where the damage occurred:

The head is at the site of the mobile metacarpophalangeal joint of the bones.
The base is in .
Central part.

There is also a classification depending on what part of the metacarpal bone was damaged:

1 metacarpal bone – when the first metacarpal bone is fractured, doctors distinguish 2 types of injury: Bennett’s fracture and a fracture without dislocation.

Bennett's fracture(location – base of the hand bone) is characterized by damage to a triangular fragment on the side of the elbow. There is no displacement, only dislocation is observed. Most often, injury occurs as a result of mechanical damage, affecting the axis of the thumb (due to an impact, a heavy object falling on the hand). Symptoms: pain in the area of injury, it is impossible to palpate the area due to severe pain, it is impossible to remove the finger.

In medicine, Bennett's injury can be referred to as a fracture-dislocation of the first metacarpal bone.

Deformity without subsequent dislocation is characterized by injury to the “flexion” area of the hand. This happens if you sharply bend the bone towards the palm and hit it hard. This type of injury leads to displacement of fragments of the hand into the inner part of the palm. Symptoms are similar to Bennett's injury. Damage often occurs in athletes and conflict-ridden people.

2, 3, 4 and 5 metacarpal bones.

Injuries can be of different types, with different amounts of damage. There are fractures of the 3rd metacarpal bone; fractures of the 4th and 5th metacarpal bones; fracture of the head of the metacarpal bones. These types of injuries are less common, but if they happen, you shouldn’t hesitate. In the absence of medical care and specialist consultation, the injury becomes old and the bones heal incorrectly. As a result, the functioning of the hand is impaired. Damage occurs due to impact, strong compression or squeezing.

Massage

Massage will help restore normal blood supply to tissues and cells, therefore, if there are no contraindications, self-massage is an important part of rehabilitation. Thanks to this, it will be possible to quickly develop the brush and improve the blood supply to the cells.

Consequences

An injury to the metacarpal bone of the hand can become dangerous if you do not seek help in time. grow together incorrectly, as a result of which it will be impossible to perform the simplest hand movements. It may also develop. The fracture itself subsequently brings painful sensations both during the healing process of the bones and during the rehabilitation process.

Prevention

The best preventive measure is caution, since carelessness can damage the right hand, which for many is the main, leading limb, without which it will be difficult for the victim to perform social functions.

You should not neglect safety rules; it is better to carefully study what is happening and try to avoid a possible conflict. If this fails, you should not rely on it “going away on its own” - it is better to seek help in time to prevent the consequences.

Dear readers of the 1MedHelp website, if you still have questions on this topic, we will be happy to answer them. Leave your reviews, comments, share stories of how you experienced a similar trauma and successfully dealt with the consequences! Your life experience may be useful to other readers.