Neglected Bennett Fracture: An Expanded Approach

Bennett fractures are unstable partial articular fractures of the thumb base, often leading to malunion/nonunion and trapeziometacarpal joint arthritis, if not treated promptly. This study presents 2 cases of neglected Bennett fracture nonunion treated with suture button suspension and small fragment excision, a technique not previously reported for this lesion.

Two male manual workers (24 and 43 years old. respectively) presented with thumb base pain 4 to 6 months post-trauma. Radiographs and computed tomographic scans confirmed Bennett fracture nonunion with first metacarpal base subluxation. Both underwent suture button suspension using the Mini TightRope technique (Arthrex^®) and fragment excision, followed by 2 weeks of immobilization and progressive hand therapy.

One patient resumed all activities at 3 weeks, whereas the other required 5 months due to a post-traumatic second metacarpal fracture managed conservatively. At 5 months postop, both showed similar thumb motion to presurgery levels, improved visual analog scale score, and enhanced pinch and grip strength. Radiographs demonstrated satisfactory positioning and healing. The suture button suspension technique aims to recreate ligament stability between the first and second metacarpals, restoring thumb mobility and strength. This approach may offer advantages over traditional methods, allowing earlier mobilization and potentially faster recovery. However, it may not be suitable for cases with advanced arthritis.

Suture button suspension and small fragment excision appears to be a viable treatment for Bennett fracture nonunion, offering successful outcomes and potentially overcoming some disadvantages associated with other techniques. Further research is needed to fully evaluate its long-term efficacy and safety.