1. OPERATIVE TREATMENT FOR THE FIRST METACARPAL BASE FRACTURE OF THE HAND
BUI LAN HUONG M.D, M.S.
Upper limb Surgery Department - HTO

2. INTRODUCTION
Thumb occupies a great importance of hand’s function (40%)
Fracture of the 1st metacarpal base is common
Operative treatment with K – wire is our treatment of choice.
Aim of the study:
Evaluating the result of this method

3. MATERIAL 25 patients: 20 Males (80%) 5 Females (20%)
Age: 17 – 65 (average: 38)
Right hand (dominant): 13 cases (52%)
Left hand (non dominant): 12 cases (48%)
Address: Ho Chi Minh city: 14 cases
Provinces: 11 cases

4. MATERIAL Time from injury to presentation: 1 – 120 days
(average 18 days)
Time from injury to operation: 1 – 160 days
(average 30 days)
Follow up: 3 – 54 months
(average 15 months)

6. Previous treatments
None: cases
Traditional treatment: 03 cases
Cast: cases
Operation: case

8. OPERATION TECHNIQUE
- Open reduction + K-wire fixation: 23 cases
- Closed reduction + K-wire fixation: 02 cases
Splint after operation for 4 weeks
COMPLICATION
Paraesthesia/ scar: 5 cases
(3 cases after removal of the K-wire)
Pin tract infection: 1 case

9. ASSESSMENT
- Healing of fracture
- Range of motion (excellent, good, fair, poor)
- Thumb opposition (Kapandji 1- 8)
- Grip strength: comparing with unaffected hand
- Pain intensity: VAS score
- X ray: healing, narrow CMC joint, arthrosis
- Patient’s satisfaction: VAS score

10. RESULT: Excellent: all the assessments are excellent
Good: at least 1 assessment is good
Fair: at least 1 assessment is fair
Poor: at least 1 assessment is poor, arthrosis on X ray

11. Bone healing: 25 cases (100%)
Pain:
- No pain: 22 cases (88%)
- Mild pain (VAS 3/10) with motion: 2 cases (8%)
- Pain related to the cold weather: 1 case
Opposition of the thumb: 7/8 on average (by Kapandji)

12. Antero- posterior movement
Range of motion
(compare with unaffected hand)
Number of patients
Rate %
Normal 7 28
Decreased ROM of < 20 % 12 48
Decreased ROM of 20 – 40 % 5 20
Decreased ROM 41 – 60 % 1 4
Decreased ROM of > 60 %
Total 25
100

13. Flexion - Extension Range of motion (compare with unaffected hand)
Number of patients
Rate %
Normal 14 56
Decreased ROM of < 20 % 6 24
Decreased ROM of 20 – 40 % 2 8
Decreased ROM of 41 – 60 %
Decreased ROM of > 60 % 1
Total 25
100

14. Range of thumb’s abduction
Abduction - Adduction
Range of thumb’s abduction
Number of patients
Rate %
Normal 11 44
Decreased ROM of < 20 %
Decreased ROM of 20 – 40 % 2 8
Decreased ROM of 41 – 60 % 1 4
Decreased ROM of > 60 %
Total 25
100

15. Grip strength (compare with unaffected hand)
Number of patients
Rate %
Normal 15 60
> 3/4 8 32
1/2 – 3/4 1 4
< 1/2
Total 25
100

16. X ray X ray Number of patients Rate % Good bone healing 14 56
Light deformed
(<150, < 1mm) 5 20
Severe deformed
(>150, > 1mm) 3 12
Narrow CMC joint
Total 25
100

17. Result Number of patients Rate % Excellent 14 56 Good 5 20 Fair 3 12
Patient’s satisfaction: 8.2 / 10
Return to previous occupations : 25 cases (100%)
Final result
Result
Number of patients
Rate %
Excellent 14 56
Good 5 20
Fair 3 12
Poor
Total 25
100

18. DISCUSSION 1. Healing: 100%, cancellous bone  healing in 4 – 6 weeks
2. Pain: related to the narrow CMC joint and arthritis
In our study, 3 cases have mild pain/ narrow CMC joint on X ray
3. Movement of the thumb
Adduction – abduction: 96% of excellent and good result.
Flexion – extension: 88% excellent and good result
Stiffness of MP joint found in the old cases
Thumb opposition: 7/8  good function

19. 4. Grip strength: 92% good recovering
All the patients returned to their previous occupations
5. X ray
Our study: 3 cases of old, intra-articular fractures (12%) having narrowing of the CMC joint
Timmenga: 100% (18 cases) have narrowing of the CMC joint, more severe in the bad reduced cases, follow up 11 years
Arthrosis’s percentage varies from author to author:
Brasier: 25 – 75% of arthritis with 7-year follow up
Cannon: 12 % of arthritis with 9.6 –year follow up
BRAZIER J., MOUGHABGHAB M., MIGAUD H., FONTAINE C., ELIA A., TILLIE B., Les fractures articulaires de la base du premier meùtacarpien; Etude comparative de l’osteùosyntheøse directe et de l’embrochage extra – local, Ann Chir Main, 1996, 15, 2, 91 – 99.
CANNON S.R., DOWD G.S.E., WILLIAMS D.H., SCOTT J.M., A long – term study following Bennett’s fracture, J Hand Surg, 1986, Vol 11-B, N. 3, 426 – 431.
TIMMENGA E.J. BLOKLNIS T.J, MAAS M; Long term evaluation of Bennett ‘s Fracture. A comparison between open and closed redution; J. Hand Surg, 1994, 19-B;

20. 6. K- wire pinning:
Technique: simple (Difficult in cases of old, intra-articular fractures)
Material: cheap
Mini screw – plate: no experience
7. Problems
Delayed presentation
Delayed operation
Postop Physiotherapy

21. CONCLUSION Excellent and good result 76%  acceptable
K wire fixation is a simple, cheap and effective method especially for extra articular fractures.
In delayed cases: the anatomic restoration is difficult, close reduction is impossible, outcome is limited.
 In case of conservative treatment’s failure, surgical intervention should be performed as soon as possible

22. Case 1: Male, 39yrs old
Cause: Traffic accident April 12, 2006
Diagnosis: Bennett fracture of R hand
Reduction and plaster at local hospital

23. Operation at HTO May 12, 2006

24. June12,2006: Removing first web K wire
Aug 20, 2006: Removing all K wires
Dec 4, 2008: Last evaluation (31- month follow- up)
Pain 0/10
Thumb opposition 8/8 (Kapandji)
Grip strength: R hand 20 kilos (operated hand)
L hand 18 kilos
Satisfaction: 10/10

25. Range of motion

26. Case 2: Male, 47 yrs old
Cause: Work accident (Nov, 2006)
Reduction and plaster at local hospital

27. 20/4/2007 Examination at HTO
Diagnosis: Malunion of base M1 of left hand
May 31, 2007 Osteotomy, pinning, splint

28. June 23, 2007 Removing first web K wire
Sept 27, 2007 Removing all K wires
Dec 2, Last evaluation (19 -month follow- up)
Pain 2/10
Thumb opposition 3/8 (Kapandji)
Grip strength: R hand 22 kilos L hand 6 kilos
Satisfaction: 9/10

29. Range of motion

30. Thank you