gms | German Medical Science

Objectives/Interrogation: Bennett's fractures still represent a challenge in hand surgery because of the articular involvement, the difficult management of the small fragment and the stability of fixation. Several fixation techniques have been described, such as percutaneous pinning, k-wires, screws, external fixation and arthroscopically assisted fixation. Tension-band wiring has also been described as a reliable technique and it's employable even in presence of a very small fragment. We propose a refinement of the already described tension-band wiring technique in order to preserve all its advantages but with less invasiveness and allowing an easier removal of the device.

Methods: By means of a standard Wagner J-shaped incision at the base of the first metacarpal, the fracture is exposed and reduction is obtained with direct visualization of the articular surface. A k-wire 1.2mm is inserted from the dorsal aspect of the metacarpal base through the fragment until the exposure of 2-3mm of its tip at the volar side. A second k-wire is then used to perforate the metacarpal, parallel but just 5mm distal to the first k-wire. A 0.4mm metal cerclage loop is then passed through the second hole and anchored to the tip of the first k-wire. Dorsally the two tails of the cerclage are then twisted and secured around the tail of the k-wire, previously bent and cut, applying the desired compression. A removable splint is applied in the immediate post-op time and assisted rehabilitation starts within a week. We have treated three cases with this technique so far and in just one case the device has been removed ten months after fixation. The removal took just five minutes under local anesthesia by means of a small dorsal incision, removing the k-wire first and then extracting the metal cerclage with no need to cut it.

Results and Conclusions: All the fractures achieved the radiological consolidation within 6 weeks and the full range of motion was recovered within 3 months in all cases. The satisfaction of the patients was high and there were no complications even at the time of second surgery.

In conclusion, tension-band wiring for treatment of Bennett's fractures gives several advantages comparing to other devices such as a stable fixation even with very small fragments, a strong compression at the site of fracture and a low cost. Furthermore, our intraosseous refinement of the technique allows the removal of metal devices very easily in a safe and minimally invasive way.