Article Text

Management of undisplaced Bennett's fracture
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1. Bruce Martin1,
2. Martin Smith2
1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL
2. 1Clinical Fellow
3. 2Specialist Registrar

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Report by Bruce Martin; Search checked by Martin Smith

Clinical scenario

A 32 year old man presents to the emergency department following a fight. He complains of pain around the base of the right thumb metacarpal. Radiography reveals an undisplaced Bennett's fracture. You wonder whether he should be treated conservatively or surgically.

Three part question

In [an adult patients with an undisplaced Bennett's fracture] is [conservative management better than surgical management] at [minimising time to recovery and final disability]?

Search strategy

Medline 1966 to 10/99 using the OVID interface. [{exp fractures OR exp fractures, closed OR fracture$.mp} AND [({exp thumb OR thumb.mp OR first.mp} AND {exp metacarpus OR metacarp$.mp}) OR Bennett$] AND {exp emergency treatment OR exp treatment outcome OR treatment$.mp OR treat\$.mp}] LIMIT to human AND english.

Search outcome

Ninety eight papers were found of which 92 were irrelevant or of insufficient quality for inclusion. The remaining six papers are shown in table 2.

Table 2

Comment

The evidence in this area is extremely poor. All studies are small and retrospective. A well designed prospective randomised controlled trial is needed.

Clinical bottom line

Good initial reduction probably reduces the incidence of later arthrosis of the base of the thumb metacarpal. There is no evidence to help decide whether a conservative or a surgical approach is preferable.

Report by Bruce Martin; Search checked by Martin Smith

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