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It is possible to place the osteosynthesis in ulna-radial fashion from the smaller fragment achieving correct reduction and stabilization. The volar approach offers an excellent fracture exposure. The complete visualization of the first metacarpal articular surface is hard to accomplish from the dorsoradial aspect of the hand. No sensory disturbances around the scar were recorded. The mean visual analog scale score was 0. Its base has a saddle-shaped facet for the trapezium. The thumb metacarpal is shorter and thicker. Grip strength averaged 84.6% of the opposite side. The metacarpal bones run from the carpus, forming the carpometacarpal joints, to the base of proximal phalanges, forming the metacarpophalangeal joints. The mean distance between the tip of the thumb and the fifth metacarpophalangeal joint was less than 10 mm reposition was complete. One secondary displacement was registered. Mean follow-up was 8 months.Īnatomical reduction was achieved in all cases. Sensitive areas around the scar were evaluated. At final follow-up, we assessed the thumbs for range of motion, residual pain, and grip strength. The articular step-off, secondary displacement incidence and consolidation rate time were measured. Fixation was done with micro-screws or K-wires, always placed from ulnar to radial during thumb supination. The purpose of this article is to assess the surgical treatment using a direct volar approach.īetween March 2008 and December 2014, 21 patients with intra-articular first metacarpal fractures displaced more than 1 mm were operated on using a direct volar approach. Later, open reduction and internal fixation was advocated. the Bennett fracture at the base of the first metacarpal), with the treatment methods varying accordingly as well 8. Early reports supported closed reduction and casting with or without percutaneous pinning. What is the 1st metacarpal (thumb metacarpal), where is it located, development, anatomy (surfaces, thumb metacarpal joints & articulations), pictures. Management of Bennett fractures has been controversial.