Fractures of the base of the first metacarpal in children. Role of K-wire stabilisation.
In order to define the factors of instability of fractures of the base of the first metacarpal in children, the authors reviewed 30 children presenting this lesion with a follow-up greater than 10 months. Patients in whom the growth cartilage of the base of the first metacarpal was still open and presenting a fracture with angular displacement greater than 30 degrees or metaphyso-epiphyseal sliding greater than 1 mm were included. Three groups were defined on the basis of radiographic findings: Group A: pure metaphyseal fractures (14 cases: 10 pinnings and 4 orthopaedic treatments); Group B: Salter II epiphyseal detachment fractures with a medial metaphyso-epiphyseal corner (10 cases: 1 pinning and 9 orthopaedic treatments); group C: Salter II epiphyseal detachment fractures with a lateral metaphyso-epiphyseal corner (6 cases: 2 pinnings and 4 orthopaedic treatments). The authors studied early secondary displacements as a function of the emergency treatment modality. No secondary displacement was observed for group B lesions regardless of treatment and for lesions stabilized immediately by intermetacarpal pinning. In contrast, one half of group A and C lesions treated orthopaedically subsequently became displaced, requiring surgical revision with stabilization by pinning. The authors recommend orthopaedic treatment for group B lesions and immediate surgical stabilization for group A and C lesions.
Jehanno
P
P
Hôpital René-Debré, Paris.
Iselin
F
F
Frajman
J M
JM
Penneçot
G F
GF
Glicenstein
J
J
D000293:Adolescent; D001858:Bone Nails; D001864:Bone Wires; D002648:Child; D002675:Child, Preschool; D004838:Epiphyses / Q000293:injuries; D005260:Female; D005500:Follow-Up Studies; D005592:Fracture Fixation / Q000295:instrumentation*; D017102:Fracture Healing; D050723:Fractures, Bone / Q000145:classification / Q000601:surgery*; D006801:Humans; D004204:Joint Dislocations / Q000601:surgery; D008297:Male; D008663:Metacarpus / Q000293:injuries*; D012086:Reoperation; D012189:Retrospective Studies; D000072042:Salter-Harris Fractures; D013933:Thumb / Q000293:injuries*