Is Percutaneous Fixation Always Necessary in Bennett Fractures? Comparable Mid-Term Outcomes with Superior Early Recovery After Closed Reduction and Casting

Objective: The optimal management of Bennett fractures remains controversial, with percutaneous fixation providing superior outcomes compared with immobilization alone. This study compared closed reduction followed by thumb spica short-arm casting (CR-TSC) with closed reduction and percutaneous Kirschner wire (PKW) fixation in adult patients. Methods: This retrospective comparative cohort study included adult patients treated for Bennett fractures between 2015 and 2024. Outcomes were assessed using pain intensity (Visual Analog Scale), upper extremity disability (Disabilities of the Arm, Shoulder and Hand [DASH]), and thumb opposition (Kapandji score). Radiographic union, maintenance of reduction, length of hospital stay, time to return to work, and complications were evaluated. Results: Fifty-four patients were analyzed (CR-TSC, n = 31; PKW, n = 23). Early postoperative pain was significantly higher in the PKW group on postoperative day 1, while pain levels were comparable by week 4 and at final follow-up. Mid-term DASH scores did not differ between groups. Thumb opposition was significantly better, and return to work was earlier in the CR-TSC group. All fractures achieved union. Two transient superficial pin-tract infections occurred after PKW. Conclusion: When acceptable closed reduction is achievable, CR-TSC provides mid-term outcomes comparable to PKW while offering advantages in early pain, thumb opposition, and faster return to work, suggesting its role as an effective, patient-centered treatment option for Bennett fractures. Cite this article as: Kocak S, Ertürk C. Is percutaneous fixation always necessary in Bennett fractures? Comparable mid-term outcomes with superior early recovery after closed reduction and casting. Cerrahpaşa Med J. 2026, 50, 0022, doi: 10.5152/cjm.2026.26022.