Best Evidence Topics
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Little evidence for conservative or operative management of undisplaced Bennett's fractures

Three Part Question

In [an adult patient with an undisplaced Bennetts' fracture] is [conservative management better than surgical management] at [minimising time to recovery and final disability]?

Clinical Scenario

A 32 year old man presents to the Emergency Department following a fight. He complains of pain around the base of the right thumb metacarpal. X-ray reveals an undisplaced Bennetts' fracture. You wonder whether he should be treated conservatively or surgically.

Search Strategy

Medline 1966-10/99 using the OVID interface.
[{exp fractures OR exp fractures, closed OR fracture$.mp} AND [({exp thumb OR OR} AND {exp metacarpus OR metacarp$.mp}) OR Bennett$] AND {exp emergency treatment OR exp treatment outcome OR treatment$.mp OR treat$.mp}] LIMIT to human AND english.

Search Outcome

98 papers found of which 92 irrelevant or of insufficient quality for inclusion. The remaining six papers are shown in the table.

Relevant Paper(s)

Author, date and country Patient group Study type (level of evidence) Outcomes Key results Study Weaknesses
van Niekerk JL and Ouwens R,
12 of 23 patients with fractures at the base of the thumb metacarpal treated surgicallyRetrospective surveyLimitation of activities of daily livingNo limitationsSmall numbers Uncontrolled
Kjaer-Petersen K et al,
41 patients with Bennett's fracture treated variously (9 closed reduction, 6 percutaneous K wires, 26 open reduction). Followed up at a median of 7.3 years.Retrospective surveyResidual symptomsNo symptoms in 15 of 18 with good reductions compared with 6 of 13 with residual displacement.
Livesley PJ,
17 patients with Bennett's fracture treated conservatively Followed up at a mean of 26 years.Retrospective surveyResidual symptoms7 of 17Small numbers Uncontrolled
Range of movement and grip strengthReduced in all patients
Thurston AJ and Dempsey SM,
New Zealand
21 of 76 patients with Bennett's fracture Followed up at a mean of 7 years 7 monthsRetropective surveyResidual symptoms Less if residual fracture displacement less than 1mm. Method of reduction immaterialSmall numbers
Timmenga EJ et al,
18 patients with Bennett's fracture. Closed reduction with K wire fixation (7) vs open reduction and bone graft (11) Followed up at a mean of 10.7 yearsRetropective surveyThumb mobilityFull in all casesSmall numbers
Grip strengthReduced in all cases
OsteoarthritisDegree correlated with the residual displacement
Oosterbos CJ and de Boer HH,
20 of 22 patients with Bennett's fracture treated by closed reduction and plaster immobilisation.Retrospective surveySubjective outcomeSatisfactory in 18 of 20Small numbers Uncontrolled
Development of arthrosis7 of 20. in 6 of these original reduction had been nonanatomic


The evidence in this area is extremely poor. All studies are small and retrospective. A well designed PRCT is needed.

Clinical Bottom Line

Good initial reduction probably reduces the incidence of later arthrosis of the base of the thumb metacarpal. There is no evidence to help decide whether a conservative or a surgical approach is preferable.


  1. van Niekerk JL and Ouwens R. Fractures of the base of the first metacarpal bone: results of surgical treatment. Injury 1989;20(6):359-62.
  2. Kjaer-Petersen K, Langhoff O, Andersen K. Bennett's fracture. J Hand Surg (Br) 1990;15(1):58-61.
  3. Livesley PJ. The conservative management of Bennett's fracture-dislocation: a 26-year follow-up. J Hand Surg (Br) 1990;15(3):291-4.
  4. Thurston AJ and Dempsey SM. Bennett's fracture: a medium to long-term review. Aust New Zealand J Surg 1993;63(2):120-3.
  5. Timmenga EJ, Blokhuis TJ, Maas M et al. long-term evaluation of Bennett's fracture. A comparison between open and closed reduction. J Hand Surg (Br) 1994;19(3):373-7.
  6. Oosterbos CJ and de Boer HH. Nonoperative treatment of Bennett's fracture: a 13 year follow-up. J Orthop Trauma 1995;9(1):23-7.