Closed Reduction of Severely Angulated Rockwood and Wilkins’ Type C Thumb Metacarpal Base Fractures in Children

Abstract

Background： Management of severely angulated Rockwood and Wilkins’ type C(RW-C) thumb metacarpal base fractures in children is challenging. We report experiences of percutaneous leverage reduction and dual antegrade crossing Kirschner (DACK) wire fixation in these fractures, aiming to assess the results using our reduction technique.Methods：From October 2011 to September 2015, A total of 17 patients with severely angulated RW-C thumb metacarpal base fractures were treated at our hospital. The injured arm, including the entire first ray, was immobilized with a thumb-spica cast for 4-6 weeks and evaluated radiologically and clinically. Percutaneous leverage reduction and DACK wire fixation were successfully performed for 17 patients. No patients were treated with open reduction. 16 patients were followed up for a mean of 32 months (range 24-41 months). The results were assessed using the modified Mayo score. The level of significance was set to be p<0.05.Results：There were 9 girls and 7 boys with ages ranging from 7.5 to 14.0 years and an average age of 10.8 years. Percutaneous leverage reduction and DACK wire fixation were successfully performed within an average total surgery time of 20 minutes (range 12-32 minutes). Bone union was achieved in all patients within a mean time of 4.2 weeks (range 4-6 weeks). The average angulation (preoperation: 50.5° (range 40.8°–67.0°) vs postoperation: 5° (range 0.0°–7.0°)) significantly changed from before to after surgery (P<0.05). The clinical results were evaluated by the modified Mayo score, and there were 15 patients with an excellent outcome and one patient with a good outcome. Cosmetic results were described as good and satisfactory by all patients. There were no refractures and no incidences of nonunion, growth arrest in the proximal epiphysis. Only one patient suffered from a superficial infection, which was resolved after the removal of the k-wires and the administration of oral antibiotics. Conclusion： Our percutaneous leverage technique with DACK wire fixation can be successfully used to treat these fractures. This technique is simple to learn and minimally invasive, and the results are satisfactory. It may be an appropriate choice for the treatment of irreducible RW-C fractures.