Closed reduction external fixator fixation versus open reduction internal fixation in the patients with Bennett fracture dislocation / 中华医学杂志(英文版)

ABSTRACT

<p><b>BACKGROUND</b>The Bennett fracture is either a common or a challenging problem to hand surgeons. It is still debated whether closed or open reduction gives optimal results. This study aimed to describe and assess a closed reduction and mini-external fixator fixation technique for the treatment of Bennett's fracture dislocation and to compare this technique versus open reduction and internal fixation.</p><p><b>METHODS</b>From October 2002 to December 2012, 56 patients with Bennett's fracture dislocation were treated by closed reduction and mini-external fixator fixation and 32 patients were treated by open reduction and internal fixation in Jishuitan Hospital. Patients with an articular step-off of more than 1 mm were excluded. All patients were assessed at a mean follow-up of 7 years (range 2-10 years) and the two groups were compared with pain levels, active range of trapeziometacarpal motion, grip strength and pinch strength, arthritic changes, and adduction deformity.</p><p><b>RESULTS</b>Based on primary closed reduction maintained , the rate of anatomic reduction is 63.6%. Radiographic fracture union was achieved in all patients at a mean time of 5 weeks. At the final follow-up, there was no difference between the two groups in mean union time and pain levels (P = 0.2). There was also no difference between the two groups regarding the active range of trapeziometacarpal motion (P = 0.3), grip stength (P = 0.6), pinch strength (P = 0.2), arthritic change and loss of reduction (P = 0.2). There was a significant correlation between adduction deformity and the development of arthritis (P = 0.02).</p><p><b>CONCLUSION</b>Closed reduction mini-external fixator fixation should be first tried to apply in the treatment of Bennett's fracture dislocation, and open reduction internal fixation should only be performed for irreducible fractures.</p>