Muscle-sparing dorsal approach for Bennett fracture osteosynthesis

Area of Science:

• Orthopedic Surgery
• Hand Surgery
• Trauma Surgery

Background:

• Bennett fractures, involving the first metacarpal base and trapeziometacarpal (TMC) joint, are inherently unstable.
• Open reduction is often necessary when closed reduction fails, typically using a radiopalmar approach that detaches thenar muscles.

Purpose of the Study:

• To evaluate the long-term results of a muscle-sparing dorsal approach for treating Bennett fractures.
• To compare functional outcomes and patient-reported symptoms with the healthy contralateral hand.

Main Methods:

• A cohort of 53 patients with Bennett fractures underwent surgical reduction and screw osteosynthesis via a dorsal approach over 15 years.
• Follow-up included objective measurements of hand mobility and strength, alongside subjective assessments using the Disabilities of the Arm, Shoulder, and Hand (DASH) and German Thumb Disability Examination (TDX-G) questionnaires.

Main Results:

• 33 patients were available for follow-up at an average of 8.2 years post-surgery.
• Significant reductions were observed in radial (5%) and palmar (6%) abduction; other measurable differences were not significant.
• Mean DASH and TDX-G scores were 4.6 and 5.7, respectively, with 4 complications reported overall.

Conclusions:

• The dorsal, muscle-sparing approach is a safe and effective alternative to the radiopalmar approach for Bennett fractures.
• Despite measurable movement limitations, patients experience minimal long-term restrictions in their daily lives.