Fracture-dislocation of the base of the first metacarpal bone

　　Fracture-dislocation of the base of the first metacarpal bone is often caused by axial violence transmitted from the fingertips. The traumatic mechanism of the fracture-dislocation of the base of the first metacarpal bone (Bennett fracture-dislocation) is similar to that of a base fracture, mostly caused by axial violence transmitted from the fingertips. However, there is a fracture entering the joint at the proximal end of the first metacarpal bone. The metacarpophalangeal joint is a saddle joint, and the articular surface of the base of the first metacarpal bone and the articular surface of the trapezium are both saddle-shaped, with the two saddle shapes interlocked like the thumbs of both hands spread wide and inserted into each other, allowing for anterior, posterior, left, and right movements. After the anterior-inferior angle of the metacarpal base breaks, the metacarpal bone dislocates towards the radial side and proximally (towards the outer and lower side), and the broken triangular bone fragment is fixed to the ligament connecting the trapezium and the second metacarpal bone. If it is not reduced, the base of the metacarpal bone will protrude, localized pain and tenderness will be present, the movement of the first metacarpal carpal joint will be limited, and the radial abduction, expansion of the thumb web, and opposition function will all be affected.

　　Fracture-dislocation of the base of the first metacarpal bone commonly accompanies injuries to nerves and blood vessels. For patients with associated fractures, abnormal joint movement, pain, and signs such as crepitus and grinding sounds on examination may be present, indicating specific signs of fracture complications. Fracture-dislocation of the base of the first metacarpal bone can damage the radial nerve branches, causing abnormal sensory function of the 'three and a half fingers'. If the dislocated individual sustains a vascular injury, localized hematoma and pain may occur due to vascular rupture.

　　The clinical manifestations of fracture dislocation at the base of the first metacarpal bone include pain and swelling at the wrist掌关节, a marked prominence on the radial side, local tenderness, and the thumb showing mild flexion and adduction deformity. The function of thumb adduction, abduction, and opposition is limited. X-ray films show a fracture of the palmar side of the base of the first metacarpal bone, accompanied by wrist掌关节 dislocation or subluxation.

　　Although fractures can occur at any part of the first metacarpal bone, fractures at the base are more common. Base fractures can be divided into two types: intra-articular and extra-articular. The former includes Bennett fracture and Rolando fracture, which are mostly caused by axial violence transmitted from the fingertips.

　　Fracture dislocation at the base of the first metacarpal bone is often caused by axial violence transmitted from the fingertips. Therefore, to prevent fracture dislocation at the base of the first metacarpal bone, it is necessary to avoid the occurrence of violent events. When a violent event causes this disease, emergency measures should be taken.

　　During diagnosis, in addition to relying on clinical manifestations, auxiliary examinations are also needed. X-ray films can be taken for the fracture dislocation at the base of the first metacarpal bone, which can clearly show the fracture dislocation at the base of the first metacarpal bone.

　　Patients with fracture dislocation at the base of the first metacarpal bone, in addition to general treatment, should also pay attention to regulating their diet.

　　1. Avoid sour, spicy, hot, and greasy foods in the early stage:Especially avoid eating rich and nourishing foods prematurely, such as bone soup, fatty chicken, and stewed fish, otherwise, blood stasis will accumulate and be difficult to disperse, which will inevitably delay the course of the disease, slow down the growth of calluses, and affect the recovery of joint function in the future.

　　2. Avoid eating too many meat bones:Some people believe that eating more meat bones after a fracture can promote early healing. However, this is not the case. Modern medicine has proven through multiple practices that eating more meat bones by fracture patients not only does not promote early healing but may even delay the healing time of fractures. The reason for this is that after the injury, the regeneration of bone mainly relies on the function of the periosteum and bone marrow, and the periosteum and bone marrow can only better perform their functions under the condition of increasing bone collagen. The main components of meat bones are phosphorus and calcium. If a large amount is consumed after a fracture, it will promote an increase in inorganic components within the bone, leading to a disorder in the ratio of organic components within the bone, thus producing a hindering effect on the early healing of fractures. However, the fresh meat bone soup has a delicious taste and can stimulate appetite, so eating a small amount is not harmful.

　　3. Avoid one-sided dieting:Fracture patients often have local edema, congestion, hemorrhage, and muscle tissue damage, and the body itself has resistance and repair capabilities for these conditions. The raw materials for the repair of tissues, the growth of muscle in long bones, the formation of calluses, and the resolution of blood stasis and swelling rely on various nutrients. Therefore, ensuring smooth healing of fractures is crucial, and nutrition is the key.

　　4. Avoid indigestible foods:Fracture patients are restricted in activity due to the fixation of plaster or splints, and the swelling and pain at the injury site, along with mental anxiety, often lead to a loss of appetite and constipation.

　　5. Avoid excessive sugar intake:After consuming a large amount of sugar, a rapid metabolism of glucose will occur, thus producing intermediate metabolites such as pyruvate and lactic acid, causing the body to be in an acidic poisoning state. At this time, alkaline calcium, magnesium, sodium, and other ions will be immediately mobilized to participate in neutralization to prevent the blood from becoming acidic. Such a large consumption of calcium is not conducive to the recovery of fracture patients. At the same time, excessive sugar will also reduce the content of vitamin B1 in the body, which is because vitamin B1 is a necessary substance for the conversion of sugar into energy in the body. Insufficient vitamin B1 greatly reduces the activity of nerves and muscles, and also affects the recovery of function. Therefore, fracture patients should avoid eating too much sugar.

　　6. Avoid long-term use of Sanqi tablets:During the early stage of a fracture, local internal bleeding occurs, blood stasis, swelling, and pain. At this time, taking Sanqi tablets can constrict local blood vessels, shorten blood coagulation time, increase thrombin, which is very appropriate. However, after the fracture is reduced for a week, bleeding has stopped, and the damaged tissue begins to repair. Since repair requires a large amount of blood supply, if Sanqi tablets are continued to be taken, the local blood vessels are in a state of constriction, and blood circulation is not smooth, which is not conducive to fracture healing.

　　7. Avoid drinking fruit juice after a fracture:The raw materials for fruit juice are made by mixing sugar water, flavoring, pigments, and other ingredients. It does not contain vitamins and minerals needed by the human body. Because it contains a lot of sugar, it is physiologically acidic after drinking.

　　When the first metacarpal base fracture dislocation occurs, the first aid measures are as follows:

　　1. Have the patient sit down, fold a clean gauze or handkerchief, and cover the injured hand with it.

　　2. Place the injured forearm across the chest, and suspend and stabilize it with a triangular bandage or bandage. You can also wrap a triangular bandage or bandage around the patient's chest, tie it on the healthy side, and place a soft pad between the tie and the body.

　　3. After bandaging is completed, check the patient's blood circulation. The method of inspection can be found in the relevant content of this book under 'Bandaging of Injuries'.

　　4. When the patient is sent to the hospital, they should be in a sitting position.