Opinions vary considerably on the frequency of late symptoms following unsatisfactory reductions of a Bennett's fracture. Casualty officers do not usually find it an easy fracture to reduce, and because it is also quite a common injury, one can presume that numerous cases must be treated inexpertly every year; but even so, the number of cases presenting themselves with symptoms of traumatic arthritis is remarkably few. However, this is no reason why a high standard of manipulative reduction should not be expected. The reduction of this fracture presents no great mechanical difficulty but it demands from the surgeon a fine sense of touch, and for this reason the injury could well be used as a ‘passing-out’ test for the student of closed reduction.

ANATOMY OF THE FRACTURE

As its alternative name implies, the ‘stave’ fracture is often sustained in a bout of fisticuffs. An ill-delivered blow transmits force in the line of the thumb while in flexion, thereby shearing off the anterior part of the base of the metacarpal, and so allowing the bone to escape from the joint in a dorsal direction. The volar ligament of the carpo-metacarpal joint remains intact and this is responsible for holding the wedge-shaped fragment of the metacarpal in its normal relation with the articular surface of the trapezium. The essential deformity of this injury is one of angulation with the concave aspect on the volar side; the intact soft tissues which are to act as the ‘hinge’ for the reduction are thus to be found on the volar aspect of the base of the metacarpal.