Qiao Fei, Shang Xinpeng, Jiang Fei
Department of Pediatric Orthopaedic, Dalian Women and Children's Medical Group, Dalian, Liaoning, China.
Front Pediatr. 2024 Aug 5;12:1394853. doi: 10.3389/fped.2024.1394853. eCollection 2024.
The treatment of severely displaced Rockwood and Wilkins' type C (RWC) thumb metacarpal basal fractures remains controversial in children. This retrospective study aimed to compare the efficacy of two treatment methods, open vs. closed reduction with pinning of such injuries.
This study included 30 patients with open physes, 14 boys and 16 girls, who all received either closed or open reduction treatment. The primary outcomes of interest included healing time, complications, and functional results, which were evaluated using the improved Mayo score standard. The minimum follow-up period was 24 months, with a mean of 30.3 months (range 24.0-45.0 months). Statistical significant was defined as < 0.05.
All fractures were healed within 7 weeks after surgery, regardless of which surgical approach was used. However, the recovery time was markedly faster in the closed group, with a mean of 4.2 weeks, than in the open group, with a mean of 4.7 weeks ( < 0.05). The operation time for closed group, taking 20 min in average, was also shorter than that for open group ( < 0.05). The total incidence of mild complications was lower for patients in the closed group than for patients in the open group (6.3% vs. 21.4%, 0.05). No major complications were observed in either group. In the closed group, a total of 15 patients exhibited excellent outcomes, while only one patient demonstrated good outcomes. On the other hand, in the open group, 12 patients experienced excellent outcomes, whereas two patients had good outcomes. There were no instances of osteomyelitis, refractures or nonunion, avascular necrosis (AVN), or premature physeal closure in either group.
The data from the open group and closed group procedures for severely shifted RWC fractures in children indicate comparable prognoses and complication rates between the two groups. Obviously closed reduction, in particular, offers several advantages over open procedure, including shorter surgical duration, fewer K-wires required, and no need for open incisions. Consequently, closed reduction is the preferred method for treating such RWC fractures.
儿童严重移位的罗克伍德和威尔金斯C型（RWC）拇指掌骨基底骨折的治疗仍存在争议。本回顾性研究旨在比较两种治疗方法的疗效，即开放性复位与闭合性复位并穿针治疗此类损伤。
本研究纳入30例骨骺开放的患者，其中14例男孩，16例女孩，均接受了闭合或开放复位治疗。主要关注的结果包括愈合时间、并发症和功能结果，采用改良的梅奥评分标准进行评估。最小随访期为24个月，平均为30.3个月（范围24.0 - 45.0个月）。统计学显著性定义为P < 0.05。
无论采用哪种手术方法，所有骨折均在术后7周内愈合。然而，闭合组的恢复时间明显更快，平均为4.2周，而开放组平均为4.7周（P < 0.05）。闭合组的手术时间平均为20分钟，也比开放组短（P < 0.05）。闭合组患者轻度并发症的总发生率低于开放组（6.3%对21.4%，P < 0.05）。两组均未观察到严重并发症。在闭合组中，共有15例患者表现出优秀的结果，而只有1例患者表现良好。另一方面，在开放组中，12例患者结果优秀，而2例患者结果良好。两组均未发生骨髓炎、再骨折或骨不连、缺血性坏死（AVN）或骨骺过早闭合的情况。
儿童严重移位的RWC骨折的开放组和闭合组手术数据表明，两组的预后和并发症发生率相当。显然，闭合复位尤其比开放手术具有几个优势，包括手术时间更短、所需克氏针更少，且无需开放切口。因此，闭合复位是治疗此类RWC骨折的首选方法。
