This is Bennett's own 1886 paper describing the intra-articular fracture-dislocation at the base of the first metacarpal that now bears his name. The paper defines the fracture anatomy, argues that prior reports of 'partial thumb metacarpal luxation' were this fracture misdiagnosed, and corrects his earlier claim that it occurs only on the right hand. It remains the primary source for one of the most tested hand fractures in orthopedic education.
Any apparent 'partial subluxation' at the base of the thumb should be treated as a Bennett fracture until proven otherwise. The sellar geometry of the first CMC joint physically prevents a stable partial dislocation, so if it looks like one, there is a fracture producing that appearance.
When you see a dorsal prominence at the first metacarpal base after trauma, elicit crepitus by compressing the base between finger and thumb while applying longitudinal traction. A positive response confirms the diagnosis even without imaging.
Swelling in the first 30-60 minutes commonly obscures the fracture on exam. If the initial visit is negative but the mechanism is right, re-examine once swelling subsides. Bennett's own case went undiagnosed for seven days precisely because of early swelling.
Left untreated, this fracture may spare daily function for years while producing lasting deformity. Early recognition and four weeks of splinted reduction is the intervention that changes the outcome.
This is Bennett's own 1886 paper describing the intra-articular fracture-dislocation at the base of the first metacarpal that now bears his name. The paper defines the fracture anatomy, argues that prior reports of 'partial thumb metacarpal luxation' were this fracture misdiagnosed, and corrects his earlier claim that it occurs only on the right hand. It remains the primary source for one of the most tested hand fractures in orthopedic education.
Any apparent 'partial subluxation' at the base of the thumb should be treated as a Bennett fracture until proven otherwise. The sellar geometry of the first CMC joint physically prevents a stable partial dislocation, so if it looks like one, there is a fracture producing that appearance.
When you see a dorsal prominence at the first metacarpal base after trauma, elicit crepitus by compressing the base between finger and thumb while applying longitudinal traction. A positive response confirms the diagnosis even without imaging.
Swelling in the first 30-60 minutes commonly obscures the fracture on exam. If the initial visit is negative but the mechanism is right, re-examine once swelling subsides. Bennett's own case went undiagnosed for seven days precisely because of early swelling.
Left untreated, this fracture may spare daily function for years while producing lasting deformity. Early recognition and four weeks of splinted reduction is the intervention that changes the outcome.