Fractures of the base of the first metacarpal in children. Role of K-wire stabilisation.

ABSTRACT

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.