Department of Orthopedic Surgery, Qilu Hospital of Shandong University, Jinan, 250012, Shandong, China.
Department of Pediatric Orthopaedic, Dalian Women and Children's Medical Center (group), Dalian, 116012, Liaoning, China.
BMC Musculoskelet Disord. 2021 Sep 12;22(1):775. doi: 10.1186/s12891-021-04665-z.
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.
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.
The patients included 9 girls (56.2%) and 7 boys (43.8%), with an average age of 10.8 years (range 7.5 to 14.0 years). Percutaneous leverage reduction and DACK wire fixation were successfully performed within an average total surgery time of 20 min (range 12-32 min). 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: 5.0° (range 0.0°-7.0°)) significantly changed from pre to post-surgery (P < 0.05). The clinical outcomes were evaluated by the modified Mayo score: 15 patients had an excellent outcome, and one patient had 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.
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.
儿童严重成角的 Rockwood 和 Wilkins' 型 C（RW-C）拇指掌骨基底骨折的治疗具有挑战性。我们报告了经皮杠杆复位和双顺行交叉克氏针（DACK）固定治疗这些骨折的经验，旨在使用我们的复位技术评估结果。
2011 年 10 月至 2015 年 9 月，我院共收治 17 例严重成角的 RW-C 拇指掌骨基底骨折患者。受伤手臂（包括整个第一掌骨）用拇指斯皮茨石膏固定 4-6 周，并进行影像学和临床评估。17 例患者均成功进行经皮杠杆复位和 DACK 线固定，无开放性复位。16 例患者平均随访 32 个月（24-41 个月）。采用改良 Mayo 评分评估结果。显著性水平设为 p<0.05。
患者包括 9 名女孩（56.2%）和 7 名男孩（43.8%），平均年龄 10.8 岁（7.5-14.0 岁）。经皮杠杆复位和 DACK 线固定的平均总手术时间为 20 分钟（12-32 分钟）。所有患者均在平均 4.2 周（4-6 周）内获得骨愈合。平均成角（术前：50.5°（40.8°-67.0°）与术后：5.0°（0.0°-7.0°））术后明显改善（P<0.05）。改良 Mayo 评分评估临床结果：15 例患者疗效优，1 例患者疗效良。所有患者对美容效果的描述均为良好和满意。无再骨折、近侧干骺端骨不连、生长停滞。仅 1 例患者发生浅表感染，在取出克氏针并口服抗生素后得到解决。
我们采用 DACK 线固定的经皮杠杆技术可成功治疗此类骨折。该技术简单易学，微创，效果满意。对于治疗不可复位的 RW-C 骨折，可能是一种合适的选择。
