Br J Sports Med 2000;34:463–464 463

Case report

Simultaneous Bennett’s fracture and

metacarpophalangeal dislocation of the same
thumb in a soccer player
S Jari, M Waseem, M S Srinivasan

Abstract Double dislocations of finger joints are rare.1–6

Double dislocations of finger joints are Previous reports of simultaneous double
rare. An unusual case of a simultaneous thumb dislocations have included dislocation
Bennett’s fracture/dislocation of the carpo- of the thumb metacarpophalangeal and carpo-
metacarpal joint and a dorsal dislocation metacarpal joints,3 6 metacarpophalangeal and
of the metacarpophalangeal joint of the interphalangeal joints,5 and a case of inter-
same thumb, and the management of this phalangeal and carpometacarpal dislocation
injury are reported. The patient had an which also included a small avulsion flake of
excellent functional result. volar beak from the base of the metacarpal.7
(Br J Sports Med 2000;34:463–464) We report an unusual case of a simultaneous
Bennett’s fracture/dislocation of the carpo-
Keywords: finger; thumb; Bennett’s fracture; dislocation
metacarpal joint and a dorsal dislocation of the
metacarpophalangeal joint of the same thumb.

Department of
Orthopaedic Surgery,
Blackburn Royal
Infirmary, Bolton
Road, Blackburn, UK
S Jari, M Waseem, M S
Srinivasan

Correspondence to:
Mr S Jari, 14714 Brahms
Drive, Apartment 2016,
Carmel, IN 46032, USA Figure 1 Initial anteroposterior radiograph after the
[email protected] injury showing the simultaneous Bennett’s fracture of the Figure 2 Anteroposterior radiograph after surgery
first metacarpal base and the dorsal dislocation of the showing reduction and wiring of the first metacarpal base
Accepted 3 August 2000 metacarpophalangeal joint of the thumb. and reduction of the thumb metacarpophalangeal joint.

www.bjsportmed.com
464 Jari, Waseem, Srinivasan

Case report He was discharged from further follow up

A 23 year old right handed man fell on to his after one year.
outstretched left thumb after being tripped
during a tackle while playing a game of soccer.
He presented to the accident and emergency
department with a painful deformed left thumb Discussion
and no other injuries. He had no neurovascular The mechanism of injury for carpometacarpal
deficit of the thumb. joint dislocation is usually a longitudinally
A plain radiograph showed a Bennett’s directed force with the metacarpal in slight
fracture/dislocation of the carpometacarpal joint flexion, whereas the metacarpophalangeal joint
and a dorsal dislocation of the metacarpo- injury requires forced hyperextension of the
phalangeal joint of the thumb (fig 1). Under joint.2 It is felt that the injuries to the patient’s
regional anaesthetic block, the dislocations were thumb occurred to the distal joint first so as to
easily reduced in the accident and emergency fulfil both mechanisms.
department. The metacarpophalangeal joint Once reduced, the metacarpophalangeal
reduction was stable but the carpometacarpal joint was stable and the carpometacarpal joint
joint reduction was very unstable. The thumb fracture/dislocation could then be treated on its
was therefore temporarily held in a Bennett’s own merit based on the standard treatment
type plaster cast and the next morning the protocols for this injury.2
patient was taken to the operating theatre. We report a rare case of simultaneous Ben-
Under general anaesthesia, the stability of the nett’s fracture/dislocation of the carpometa-
reduced metacarpophalangeal joint was con- carpal joint and dorsal dislocation of the
firmed and the colateral ligaments felt to be metacarpophalangeal joint of the thumb and
intact. The carpometacarpal joint was reduced its management. This patient had no limita-
and the position held using two percutaneous K tion of activities after treatment of this injury.
wires, one transfixing the carpometacarpal joint
and the other through into the base of the
second metacarpal (fig 2). A Bennett’s plaster
1 Andersen MB, Johannsen H. Double dislocation of the
cast was reapplied. interphalangeal joints in the finger. Scand J Plast Reconstr
The wires were removed after three weeks Hand Surg 1993;27:233–6.
2 Green DP, Butler TE. Fractures and dislocations in the
and the stability of the metacarpophalangeal hand. In: Rockwood CA, Green DP, Bucholz RW, et al, eds.
and carpometacarpal joints reconfirmed. The Fractures in adults. 2nd ed. Philadelphia: Lippincott-Raven,
1996;1:669–73.
patient was referred for hand therapy. 3 Ibrahim S, Noor MA. Simultaneous dislocations of the car-
Three months after the injury, the patient was pometacarpal and metacarpophalangeal joints of the
thumb. Injury 1993;24:343–4.
reviewed. He had no pain or residual deformity 4 Ikpeme JO. Dislocation of both interphalangeal joints of one
of the thumb. The fracture had united and finger. Injury 1997;9:68–70.
5 Levy IM, Liberty S. Simultaneous dislocation of the
the carpometacarpal and metacarpophalangeal interphalangeal and metacarpophalangeal joints of the
joints were stable. He had regained a full range thumb: a case report. J Hand Surg [Am] 1979;4:489–90.
6 Moore JR, Webb CA, Thompson RC. A complete
of all thumb movements as compared with the dislocation of the thumb metacarpal. J Hand Surg [Am]
other side and had equal thumb-index spans of 1978;6:547–9.
17 cm bilaterally. He had returned to all his 7 Wee JTK, Chandra D, Satku K. Simultaneous dislocations
of the interphalangeal and carpometacarpal joints of the
normal activities. thumb: a case report. J Hand Surg [Br] 1988;13:224–6.

Take home message

Careful assessment of all hand injuries combined with a high index of suspicion will allow
diagnosis of uncommon combined injuries such as double fractures/dislocations, permitting
correct treatment and leading to an excellent functional recovery.

www.bjsportmed.com