Outcomes of Patients with Bennett Fracture Treated with Three Different Surgical Techniques: A Systematic Review.

Abstract

Objectives: Bennett's fracture, the most common intra-articular fracture occurring at the base of the thumb, accounts for less than 1% of all hand fractures. It typically results from specific traumatic mechanisms, deforming forces, and ligamentous injuries. To compare the functional outcomes and sequelae in patients with Bennett's fracture treated surgically using: Open reduction and internal screw fixation, closed reduction and percutaneous fixation, arthroscopy-assisted reduction and screw fixation.

Methods: A systematic literature review was conducted to identify studies on Bennett's fracture dislocations in patients over 18 years of age without additional injuries. Searches were performed in PubMed, Scopus, Cochrane Central, Web of Science, Scielo, Lilacs, Oneme, and Epistemonikos databases, with language restrictions in English, French, Spanish, Portuguese, Italian, and German, and no date restrictions. Primary outcome variables included measures of functionality and secondary outcomes such as pain, stiffness, and osteoarthritis.

Results: A total of 18 studies met the selection criteria, with most being retrospective (94.45%). Pain measures were reported in 77.78% of the studies, predominantly using the VAS (min=0 and max=2). All techniques seemed to achieve similar functional outcomes. The main difference was the pain registered at follow-up, mainly by patients treated with open reduction. Osteoarthritis appeared as a common consequence of these fractures, regardless of the treatment type -excluding arthroscopy-assisted reduction as there was not enough data.

Conclusion: The three techniques had similar functional outcomes. Closed reduction and percutaneous fixation appear to result in less pain; however, both closed reduction with percutaneous fixation and open reduction with internal screw fixation have similar rates of osteoarthritis at follow-up. Unfortunately, there is insufficient data to evaluate arthroscopy-assisted reduction with screw fixation, suggesting the need for rigorous follow-up in patients undergoing this surgical intervention.