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NewYork-Presbyterian Hospital Psychiatry
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Case of the Month - July 2018

This 34 year old male presented complaining of hand pain after fall from his bike after being swiped by a car.

Question 1 : What’s wrong with these pictures (and what is the associated eponym)?

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Answer 1:

There is an intra-articular fracture of the first metacarpal base (see arrows below.) It is called Bennett fracture (named after Edward Hallaran Bennett, professor of surgery 1837-1907 at Trinity College of the University of Dublin who described the need for prompt recognition and treatment of these fractures.) When there is an intra-articular fracture at the same location which is comminuted (rather than a simple fracture with Bennett), it is called a Rolando fracture.

Question 2 : How does this happen and why is it important to make the diagnosis early?

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Answer 2:

Bennett fractures are classically sustained with an axial load to a partially flexed thumb metacarpal. It is often seen in boxing and also with falls during sports and fall from bike while gripping handle bars.

It is crucial to align and fix the fracture early (which unfortunately doesn’t typically happen with just closed reduction and splinting) as healing with greater than 1 mm of step-off at the base increases the risk of future joint arthritis as well as greatly reduced overall hand function.

Because these fractures often present with very subtle radiologic findings, they are sometimes missed by the reading radiologist. This is one of the times that an ED doc personally reviewing images and correlating with the clinical exam and mechanism is critical.

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