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

Abstract

Background: Management of severely angulation Rockwood and Wilkins’ type C(RW-C) thumb metacarpal base fractures in children is challenging. We report experiences of leverage reduction and dual antegrade crossing Kirschner wires (DACK-wires) fixation in these fractures, aiming to assess the results using our technique.Methods: From October 2011 to September 2015, 17 children with severely angulation RW-C thumb metacarpal base fractures were treated at our institute. All patients underwent percutaneous leverage reduction and DACK-wires fixation in an average surgery time of 20 minutes (range 12 ~ 32minutes). The injured arm was immobilized of a thumb-spica cast including the entire first ray for 4-6 weeks, evaluated clinically and radiologically. The Cannon scoring system were used to evaluate the results. Percutaneous leverage and DACK-wires fixation were performed for 17 patients. No patients were treated with open reduction. 16 patients were followed up for a mean of 30 months (range 12-41 months). 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-wires were successfully used in 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 (pre-operation; 50.5° (range 40.8°–67.0°) vs post-operation: 5.0° (range 0.0°–7.0°) was significantly different(P<0.05). The clinical results were evaluated by the Cannon scoring system, and there were 15 excellent results and one good result. There were no refractures and no incidences of nonunion, growth arrest in the proximal epiphysis. Only one patient suffered from superficial infection which was resolved after removal of k-wires and oral antibiotics. Cosmetic results were described as good and satisfactory by all patients.Conclusion: Our percutaneous leverage technique with DACK-wires fixation can be successfully used to these fractures. This technique is simple to learn and minimally invasive, and the results are excellent.