Houston Methodist. Leading Medicine

Hand FAQ

Question:

I'm a football player and more specifically, the quarterback. I have a bad thumb fracture they call a Bennett's fracture. I went into surgery thinking it would be a quick and easy procedure. I thought I'd be wearing a tiny splint that I could still play football with. Instead, I came out with a big bulky dressing and a splint/cast kind of affair. I haven't seen the surgeon yet to see what happened. I'm looking for any information I can find on-line to help me figure out how soon I can get this off and get back in training.

Answer:

Bennett fractures are named for a physician who first wrote about them in the medical literature way back in 1885. The specific bone that's affected is the thumb metacarpal. Metacarpal is another word for the bone in the thumb that is closest to the wrist. The joint that is affected is the carpometacarpal (CMC) joint. This is where the base of the thumb is connected to the wrist. A Bennett fracture is a break along the bottom side of the thumb metacarpal closest to the wrist bone. The location at the base of the thumb metacarpal next to the wrist is why it affects the carpometacarpal joint. And because this is a pivotal joint that contributes to all the movements of the thumb, a close and careful fracture reduction is important. Reduction refers to putting the broken pieces of bone back together so that the bone surfaces line up exactly and the carpometacarpal joint is fully restored. The surgeon uses wires, pins, or screws (called fixation) to hold the bone in place while it heals. Usually, this type of surgery can be done arthroscopically with the aid of fluoroscopy (real-time, 3-D X-rays). The arthroscope is inserted into the joint and the broken fragment is rotated and slipped back into place carefully with a tiny probe. While holding the probe in place and keeping the bone in its perfect spot, the surgeon then fixes the bone in place using a screw, pin, or wires. When Bennett fractures of the thumb can be surgically repaired in this fashion, patients have a much better long-term result. More complex fractures may still require an open surgery. If the shaft of the bone is broken and/or the soft tissues around the area have been torn, then a more extensive reconstructive procedure may be needed that requires a full incision. Sometimes the surgeon doesn't know the full extent of the damage until inside the joint looking around with the scope. At that point, it may be necessary to back out with the arthroscope and proceed with an open incision procedure. Arthroscopic or open surgery both require splinting or casting postoperatively. If the surgeon sees that complete immobilization is needed for healing and recovery, then the cast is used. Timing of the follow-up to remove sutures and replace the cast with a half-cast or splint will be determined by the surgeon. When wires are used, these are removed four to six weeks after surgery. Athletes often wear a special protective splint that still allows them to grip the ball but full return-to-play may not occur for six weeks (when X-rays show a healed fracture). This information is only a general idea of what you might expect. Once you see the surgeon and get the big picture of what happened and why, then the necessary recommendation will be made. Randall W. Culp, MD, and Jeff W. Johnson, MD. Arthroscopically Assisted Percutaneous Fixation of Bennett Fractures. In The Journal of Hand Surgery. January 2010. Vol. 35A. No. 1. Pp. 137-140.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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