Nonoperative Management of Pediatric Type I Open Fractures

Iobst, Christopher; Tidwell, Michael; King, Wesley F.

doi:10.1097/01.bpo.0000158779.45226.74

Cited by 51 publications

(46 citation statements)

References 31 publications

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“…Each patient received 48 h of antibiotics and 13 of the patients were children [5]. In 2005, Iobst et al [6] reviewed 40 pediatric patients with type I open fractures managed non-operatively and found one patient that developed a late infection (2.5 %). These patients were hospitalized for an average of 2.5 days and received an average of 6.97 doses of intravenous antibiotics [6].…”

Section: Discussionmentioning

confidence: 99%

A protocol for the management of pediatric type I open fractures

Iobst

Spurdle

Baitner

et al. 2014

Journal of Children's Orthopaedics

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BackgroundThe management of pediatric type I open fractures remains controversial. There has been no consistent protocol established in the literature for the non-operative management of these injuries.MethodsA protocol was developed at our institution for the non-operative management of pediatric type I open forearm fractures. Each patient was given a dose of intravenous antibiotics at the time of the initial evaluation in the emergency department. The wound was then irrigated and a closed reduction performed in the emergency department. The patient was admitted for three doses of intravenous antibiotics (over approximately a 24-h period) and then discharged home without oral antibiotics.ResultsIn total, 45 consecutive patients were managed with this protocol at our hospital between 2004 and 2008. The average age was 10 (range 4–17) years. The average number of doses of intravenous antibiotics was 4.06 per patient. Thirty patients (67 %) received cefazolin (Ancef®) as the treating medication and 15 patients received clindamycin (33 %). There were no infections in any of the 45 patients.ConclusionIn this study we outline a consistent management protocol for type I open pediatric forearm fractures that has not previously been documented in the literature. Our results corroborate the those reported in the literature that pediatric type I open fractures may be managed safely in a non-operative manner. There were no infections in our prospective series of 45 consecutive type I open pediatric forearm fractures using our protocol. Using a protocol of only four doses of intravenous antibiotics (one in the emergency department and three additional doses during a 24-h hospital admission) is a safe and efficient method for managing routine pediatric type I open fractures non-operatively.

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Section: Discussionmentioning

confidence: 99%

A protocol for the management of pediatric type I open fractures

Iobst

Spurdle

Baitner

et al. 2014

Journal of Children's Orthopaedics

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“…The Dubar et al [20], Morton et al [45], and Rome et al [47] studies were excluded from our review because these were protocol/technique papers that did not present patient data or follow-up. The Lobost et al [53] study was excluded because fractures were treated solely with antibiotics, and no operative treatment occurred. Four studies [44,50,63,65] were not included in our review because they included fractures other than open tibia fractures.…”

Section: Methodsmentioning

confidence: 99%

Open fractures of the tibia in the pediatric population: A systematic review

Baldwin

Babatunde

Huffman

et al. 2009

Journal of Children's Orthopaedics

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PurposeThe management of open fractures of the tibia in a pediatric population represents a challenge to the clinician. Several case series over the course of many years have been performed describing the results of treating these injuries. It remains unclear, however, whether there is a preferred modality of treatment for these injuries, if a more severe injury confers a greater risk of infection, and if time to union is affected by Gustilo type, although trends seem to exist. The purpose of this study was to assemble the available data to determine (1) the risk of infection and time to union of various subtypes of open tibia fractures in children and (2) the changes in treatment pattern over the past three decades. Methods A systematic review of the available literature was performed. Frequency weighted mean union times were used to compare union times for different types of open fractures. Mantel Haentzel cumulative odds ratios were used to compare infection risk between different types of open fractures. Linear regression by year was used to determine treatment practices over time.Results No significant change in practice patterns was found for type I and III fractures, although type II fractures were more likely to be treated closed in the later years of the study compared to the earlier years. Type III fractures conferred a 3.5-and 2.3-fold greater odds of infection than type I and type II fractures, respectively. There was no significant difference in odds of infection between type I and II fractures. There was a significant delay in mean time to union between type I and type II fractures, and between type II and type III fractures. Conclusions With the exception of type II fractures, the philosophy of treatment of open fractures of the tibia has not significantly changed over the past three decades. Closed treatment or internal fixation are both viable options for type II fractures based on their relatively low incidence of infection. This study also demonstrates a strong relationship between Gustillo sub-types and odds of infection in this population. Not surprisingly, union rates are also delayed with increasing injury severity.

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“…Lobst et al demonstrated that Type I open fractures that were managed with non-operative management and antibiotics had little difference in infection rate when compared to an operative treatment group (2.5% versus 1.9%). 29 …”

Section: Conservative Managementmentioning

confidence: 99%

Treatment of diaphyseal forearm fractures in children

2014

Orthop Rev

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Both bone forearm fractures are common orthopedic injuries. Optimal treatment is dictated not only by fracture characteristics but also patient age. In the pediatric population, acceptable alignment can tolerate greater fracture displacement due to the bone’s ability to remodel with remaining growth. Generally, these fractures can be successfully managed with closed reduction and casting, however operative fixation may also be required. The optimal method of fixation has not been clearly established. Currently, the most common operative interventions are open reduction with plate fixation versus closed or open reduction with intramedullary fixation. Plating has advantages of being more familiar to many surgeons, being theoretically superior in the ability to restore radial bow, and providing the possibility of hardware retention. Recently, intramedullary nailing has been gaining popularity due to decreased soft tissue dissection; however, a second operation is needed for hardware removal generally 6 months after the index procedure. Current literature has not established the superiority of one surgical method over the other. The goal of this manuscript is to review the current literature on the treatment of pediatric forearm fractures and provide clinical recommendations for optimal treatment, focusing specifically on children ages 3-10 years old.

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Nonoperative Management of Pediatric Type I Open Fractures

Cited by 51 publications

References 31 publications

A protocol for the management of pediatric type I open fractures

A protocol for the management of pediatric type I open fractures

Open fractures of the tibia in the pediatric population: A systematic review

Treatment of diaphyseal forearm fractures in children

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