A Bennett’s fracture refers to a break (fracture) occurring at the base of the thumb. This often occurs when the thumb is forced backwards and towards the wrist. This fracture is easily diagnosed with x-rays. Depending on the type of fracture, there are different ways of treatment all of which may be correct. Because the fracture enters the joint between this bone and a wrist bone, it needs to be perfectly put in place and held. Sometimes a well fitting cast is enough, but often a pin may be used hold them together until they heal. There is a long-term risk of arthritis in this joint regardless of what treatment is used. Pins do not seem to change the long term risk of arthritis of the thumb coming from the fracture, but their use is still advised when necessary.
Hand fractures can be treated with:
- Non-reduction – this means the fracture is in good position and may be casted as it is. This fracture is usually left in a cast for 4 to 6 weeks or as your caregiver thinks necessary. This also depends on your rate of healing
- Closed reduction, where the bones are manipulated back into position without surgery and then casted
- ORIF (open reduction and internal fixation) – the fracture site is opened and the bone pieces are fixed into place with some type of hardware, such as a pin, etc., and then casted
Your caregiver will discuss the type of fracture you have and which treatment should be best for your problem. If surgery is the treatment of choice, the following is information for you to know and also some things to let your caregiver know about prior to surgery. It is your responsibility and very important to keep all follow-up appointments. If you don’t follow-up for ongoing care and management of this injury you may develop a permanent disability and chronic pain. If there is a problem with follow-up call your caregiver immediately.
Let your physician know about the following:
- Medications taken including herbs, eye drops, over the counter medications, and creams
- Use of steroids (by mouth or creams)
- Previous problems with anesthetics or novocaine
- Possibility of pregnancy, if this applies
- History of blood clots (thrombophlebitis)
- History of bleeding or blood problems
- Previous surgery
- Other health problems
After surgery, you will be taken to the recovery area where a nurse will watch and check your progress. Once you’re awake, stable, and taking fluids well, barring other problems you’ll be allowed to go home. Once home an ice pack applied to your operative site may help with discomfort and keep the swelling down.
Home Care Instructions
- Follow your caregiver’s instructions as to activities, exercises, physical therapy, and driving a car.
- Daily exercise is helpful for maintaining range of movement and strength. Exercise as instructed.
- To lessen swelling, keep the injured hand elevated above the level of your heart as much as possible.
- Apply ice to the injury for 15 to 20 minutes each hour while awake for the first 2 days. Put the ice in a plastic bag and place a thin towel between the bag of ice and your cast.
- Move the fingers of your casted hand several times a day.
- If a plaster or fiberglass cast was applied.
- Do not try to scratch the skin under the cast using a sharp or pointed object.
- Check the skin around the cast every day. You may put lotion on red or sore areas.
- Keep your cast dry. Your cast can be protected during bathing with a plastic bag. Do not put your cast into the water.
- If a plaster splint was applied.
- Wear the splint for one week as directed or until seen for follow-up examination.
- Do not get your splint wet. Protect it during bathing with a plastic bag.
- You may loosen the elastic bandage around the splint if your fingers start to get numb, tingle, get cold or turn blue.
- Do not put pressure on your cast or splint; this may cause it to break. Especially, do not lean plaster casts on hard surfaces for 24 hours after application or as your caregiver directs.
- Only take over-the-counter or prescription medicines for pain, discomfort, or fever as directed by your caregiver.
Seek medical care if any of the following occur
- Increased bleeding (more than a small spot) from beneath your cast or splint if there is beneath the cast as with an open reduction
- Redness, swelling, or increasing pain in the wound or from beneath your cast or splint
- Pus coming from wound or from beneath your cast or splint
- An unexplained oral temperature above102 F (38.9 C) develops
- A foul smell coming from the wound or dressing or from beneath your cast or splint
- If your caregiver has given you a follow-up appointment, it is very important to keep that appointment. Not keeping the appointment could result in a chronic or permanent injury, pain, and disability. If there is any problem keeping the appointment, you must call back to this facility for assistance.
Seek immediate medical care if
- You develop a rash, have difficulty breathing, or have any allergy problems
- Your skin or nails below the injury turn blue or gray, or feel cold or numb
- You develop severe pain under the cast or in your hand
If you do not have a window in your cast for observing the wound, a discharge or minor bleeding may show up as a stain on the outside of your cast. Report these findings to your caregiver.
Make sure you
- Understand these instructions
- Will watch your condition
- Will get help right away if you are not doing well or get worse
For more information about Bennett's fracture of the hand, please call (918) 494-AOOK (2665).