Treatment
How is a Bennett's fracture treated in athletes?
Since Dr. Bennett first described the fracture that bears his name, many authors have advocated for different methods of treatment. Much of the past scientific data on treatment is conflicting. There is certainly no uniform consensus on what initial fracture treatment results in the best long term outcome. Closed reduction (manipulation) and cast immobilization often leads to satisfactory short-term results without significant functional impairment. However, because of the extension of this fracture into the joint and the significant deforming forces from muscles, worsening fracture step-off and displacement is often seen with closed treatment methods. This is typically poorly tolerated by high level athletes, particularly in the dominant hand. If an adequate closed reduction is achieved, cast treatment may be a reasonable option provided the fracture is carefully followed and that the reduction (“good alignment of the bones”) can be maintained.
Some of the more recent literature looking at long-term follow-up has suggested that surgical treatment to restore near perfect or perfect alignment of the bones (“anatomic reduction”) results in lower rates of arthritis. Unfortunately, the correlation is not clear in the literature between radiographic arthritic changes and severity of symptoms or need for future operations to address symptomatic thumb arthritis.
More Information: Read about sports injury treatment using the P.R.I.C.E. principle - Protection, Rest, Icing, Compression, Elevation.
What if I need surgery to treat my fracture?
Treatment and surgical decision making regarding a Bennett's fracture should be undertaken by an orthopaedic surgeon or a hand surgery specialist who has experience with treating these injuries. When dealing with athletes, it is important for the surgeon to be familiar with the unique demands of the athlete. If it is determined that surgery is appropriate, the surgeon will usually align the bone fragments and use either pins or screws to hold the fracture in place. If the fracture can be reduced without making an incision, often two pins will be placed through poke holes and cut just below the skin. If the surgeon needs to make an incision to “line up” the fracture fragments, either K-wires or screws can be placed through the incision to hold the fracture fragments in place. If wires are used, they can typically be removed after the fracture shows signs of healing, usually at 4 to 6 weeks after surgery. In the athlete, especially the high level athlete, surgical intervention is more effective in stabilizing the fracture and often allows for an earlier return to sport.
Will I need to wear a cast?
If surgery is not needed, a short forearm cast that includes the thumb called a thumb spica cast is typically worn for 6 weeks. If surgery is elected, often for the first 4-6 weeks a thumb spica cast or a thumb spica splint is worn at all times to protect the fracture fragment position until healing occurs. However, each fracture severity and pattern is different. For this reason, the stability of the fracture fixation and the specific requirements of an athlete’s sport have to be carefully considered to create an individualized plan for splinting or casting.
When can I return to sports?
To answer this question, many factors have to be considered. First, the stability of the fracture after surgical treatment or nonoperative treatment has to be determined. For example, if a large fracture fragment was solidly repaired with multiple screws, the surgeon may have confidence releasing an athlete to activity sooner. In the same way, the level of athletic participation needs to be considered. The type of sporting activity also is an important factor in determining return to play. Bennett fractures are commonly seen as football injuries. If an NFL offensive lineman has a Bennett's fracture in the non-dominant hand and is surgically treated, he may be able to return to competitive play in 4 weeks and play with a padded cast or splint in place. If this same fracture occurred in the dominant hand of a quarterback, his time out of competitive play would be significantly longer. This is because the activity of accurately throwing a football requires more function from the thumb CMC joint and wearing a cast/splint is ineffective. Ultimately, the decision on when to return to sports should be determined on a case-by-case basis after careful evaluation by the treating surgeon and athlete.
If you suspect that you have a Bennett's fracture, it is critical to seek the urgent consultation of a local sports injuries doctor for appropriate care. To locate a top doctor or physical therapist in your area, please visit our Find a Sports Medicine Doctor or Physical Therapist Near You section.