[Recent fractures of the base of the 1st metacarpal bone. A study of a series of 138 cases]

Abstract

Fractures on the base of the first metacarpal are uncommon lesions, affecting young subjects and have major social repercussions (an average of 3.5 months off work). The authors have analysed the clinical and radiological results of a series of 138 recent fractures of the base of the first metacarpal with a mean follow-up of 7 years (12 month-14 years). They used a classification into 5 types (Bennett's with a large fragment = 22%, Bennett's with a small fragment = 20%, Rolando = 15%, extraarticular fractures = 36%, Comminuted fractures = 6%) which are easy to recognize on standard x-rays, or preferably on Kapandji views, allowing a standardized therapeutic approach. 70% of patients were younger than 40 and in one half of cases the causal accident was a motor vehicle accident. 12% of fractures were open and 45% were associated with other traumatic lesions. In this series, 35% of cases were treated orthopedically, 57% according to Iselin's technique, 5% by direct osteosynthesis and 3% by external fixation with a mean immobilization of 40 days. A number of clinical and radiological criteria were studied in the 88 patients reviewed. A 100-point grading system was established and, independent of the type of treatment, the authors obtained 61% of very good results, 23% of good results, 12% of moderate results, 2% of poor results and 2% of very poor results. Articular lesions constituted a factor of severity and failure to respect opening of the commissure appeared to be more pejorative than a small imperfection of reduction. The authors noted that simple treatment according to Iselin's technique still has many indications despite progress in miniaturized osteosynthesis.