Treatment

It is probably best to reduce the fracture although if untreated, the inevitable mal-union does not usually appear to impair function excessively.

Closed reduction by cast pressure may be tried initially. The injured metacarpal is held abducted and extended - usually by flexing the metacarpophalangeal joint. The adequacy of the reduction should be assessed by x-ray and the decision taken as to whether to continue - for 4 weeks - or fix internally.

Internal fixation is the preferred means of reduction - using a small percutaneous pin or Kirschner wires. A small plaster cast is retained for 3 weeks and then removed along with the internal fixator.

Note - a systematic review of patient outcomes following surgical treatment for Bennett fractures demonstrated that patients treated with closed reduction percutaneous pinning had less postoperative pain than those undergoing open reduction and internal fixation or arthroscopy-assisted reduction and screw fixation (2)

Reference

1. Goru P, Haque S, Verma GG, Mustafa A, Ebinesan A. Bennett’s Fracture Management: A Systematic Review of Literature. Cureus. 2022 Nov 10;14(11):e31340.
2. Velásquez-Girón E et al. Outcomes of Patients with Bennett Fracture Treated with Three Different Surgical Techniques: A Systematic Review. Arch Bone Jt Surg. 2025;13(1):4-16.