Fractures at the Base of the First Metacarpal Bone.

A variety of fractures occur at the base of the first metacarpal bone, the best known being that described by Bennett in 1882. A group of more comminuted fractures also involving the carpo-metacarpal joint were later described by Rolando (1910). Transverse fractures at the lower end of the metacarpal bone were mentioned by Roberts (1938) in a review of all fractures occurring in the hand. Much of the ill-repute of intra-articular fractures comes from the depressing conclusions reached by the earlier authors on the basis of a short-term review of a few cases. Opinions now vary widely, ranging from the extreme view of Blum (1941) who treated sixty patients by early active movements with good results, to some French authors (Iselin, Blanguernon and Benoist 1956 ; Creysell, Mourgues and Schnepp 1959; Razemon and Lemerle 1959) who believed that surgical intervention was essential. This difference of opinion is apparent in modern text-books, Watson-Jones (1955) stating that as a joint is involved accurate reduction is essential, and Charnley (1957), who was prepared to admit that good functional results occur even after a poor reduction. Bunnell (1956) carried out osteotomy on several maireduced Bennett’s fractures to correct deformity (loss of “ volar hook “) which he claimed led to recurrent subluxation. Many ingenious forms of operative management have been described over the years (Table I) but the value of many of them is