This retrospective study compared closed reduction and percutaneous pinning (CRPP) versus open reduction internal fixation (ORIF) methods in the treatment of severely displaced Rockwood and Wilkins’ type C (RWC) thumb metacarpal base fractures in children.
The article included 30 patients (14 boys, 16 girls; mean age 10.3 years; age range 6.2 to 14.0 years) with severely displaced RWC fractures. All patients were treated by CRPP and ORIF. The clinical results were assessed according to the criteria of modified Mayo scores. The mean follow-up period was 30.3 months (range 24.0–45.0 months). The level of significance was p <0.05.
All fractures healed within 7 weeks postsurgery, regardless of the surgery method used, and differences between groups were observed in time to union. Recovery time after CRPP treatment averaged 4.2 weeks and was faster than that after ORIF, which averaged 4.7 weeks (P<0.05). The operative time for CRPP averaged 20 minutes, which was faster than that of ORIF (P<0.05). The overall minor complication rates were 6.3% for patients in the CRPP group and 21.4% for patients in the ORIF group (P>0.05). No major complications were observed in patients in the two groups. The clinical outcomes of CRPP were evaluated by modified Mayo scores: 15 patients had excellent outcomes, and one patient had a good outcome in the CRPP group. Twelve patients had excellent outcomes, and 2 patients had a good outcome in the OPIF group. (P>0.05). There were no refractures or incidences of nonunion, avascular necrosis (AVN), osteomyelitis, or premature physeal closure.
The CRPP and ORIF data of considerably displaced RWC fractures in children revealed approximately equal results for patient outcomes and rates of complications. We assert that CRPP is superior to ORIF as a treatment for RWC fractures because CRPP minimizes the operative time, precludes the need for an incision and enables faster fracture union; thus, it is our preferred treatment method.