Open fractures of the tibia in children

Hope, PG; Wg, Cole

doi:10.1302/0301-620x.74b4.1624514

Cited by 107 publications

(48 citation statements)

References 4 publications

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“…6,12,30 The exception to this is in older children with severe open fractures who have been reported to have a substantial rate of delayed healing. 5,8,18 In this series, 3 of the 5 patients with delayed healing presented with closed injuries. Although all of the patients were older than 11 years, 3 were younger than 15 years.…”

Section: Discussionmentioning

confidence: 81%

Complications After Titanium Elastic Nailing of Pediatric Tibial Fractures

Gordon¹,

Gregush²,

Schoenecker³

et al. 2007

Journal of Pediatric Orthopaedics

115

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A retrospective review of 60 diaphyseal tibia fractures (31 closed and 29 open fractures) treated with flexible intramedullary fixation was conducted. All charts and radiographs were reviewed. Children ranged in age from 5.1 to 17 years. Fifty patients with 51 fractures were followed up until union and comprised the study group. The mean follow-up period for these 50 patients was 79 weeks. Forty-five fractures achieved bony union within 18 weeks (mean, 8 weeks). Five patients (11%) had delayed healing (3 had delayed unions that ultimately healed with casting or observation, and 2 had nonunions that required secondary procedures to achieve union [1 patient underwent a fibular osteotomy, and 1 underwent exchange nailing with a reamed tibial nail]). These 5 fractures ultimately healed, with a mean time to union of 41 weeks. Patients with delayed healing tended to be older (mean age, 14.1 years) versus the study population as a whole (mean age, 11.7 years). In addition to delayed union, other complications were observed in the study population. One patient healed with malunion (13-degree valgus), requiring corrective osteotomy. One patient with a grade II open fracture was diagnosed with osteomyelitis at the fracture site after attaining bony union. Two patients developed nail migration through the skin, requiring modification or nail removal. The fixation of pediatric diaphyseal tibia fractures with titanium elastic nails is effective but has a substantial rate of delayed healing, particularly in older patients.

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Section: Discussionmentioning

confidence: 81%

Complications After Titanium Elastic Nailing of Pediatric Tibial Fractures

Gordon¹,

Gregush²,

Schoenecker³

et al. 2007

Journal of Pediatric Orthopaedics

115

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“…Only one case resulted in operative debridement, and three patients with deep infection all had internal fixation with DCP plates or lag screws. The remainder of the studies whose patients experienced infections, whether deep or superficial, provided insufficient information in the body of the paper to ascertain the treatment that was associated with the infection [7,11,14]. The frequency weighted time to mean union was 11.6 weeks [95% confidence interval (CI)11.3-12.0 weeks] for type I fractures and 13.5 weeks (95% CI 13.2-13.9 weeks) for type II fractures.…”

Section: Resultsmentioning

confidence: 99%

“…For studies that provided the ages of the pediatric patients (12 studies, n = 581), the weighted average age at time of injury was 9.3 years (range 2-18 years) [1][2][3][4][5][6][8][9][10][11][12][13]. Gender information was provided for 675 patients (13 studies), of whom 173 (26%) were female and 502 (74%) were male [1][2][3][4][5][6][7][8][9][10][11][12][13] (25; 12%). The presence of a fibula fracture was not routinely documented in the respective studies; for consistency, we therefore chose to eliminate this from the focus of the study.…”

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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“…In 1992, Hope and Cole described their treatment of 95 open fractures of the tibia in children [79]. About 80% of these fractures were Grades I or II.…”

Section: Retrospective Non-randomized (Class Iii) Studiesmentioning

confidence: 99%

Prophylactic Antibiotic Use in Open Fractures: An Evidence-Based Guideline

Hauser

Adams

Eachempati

2006

Surgical Infections

220

116

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The data support the conclusion that a short course of first-generation cephalosporins, begun as soon as possible after injury, significantly lowers the risk of infection when used in combination with prompt, modern orthopedic fracture wound management. There is insufficient evidence to support other common management practices, such as prolonged courses or repeated short courses of antibiotics, the use of antibiotic coverage extending to gram-negative bacilli or clostridial species, or the use of local antibiotic therapies such as beads. Large, randomized, blinded trials are needed to prove or disprove the value of these traditional approaches. Such trials should be performed in patients with high-grade fractures who (1) are well-stratified according to the degree of local injury and (2) undergo standardized fracture and wound management. Trials also must be powered to study the effects of extended antibiotic coverage on nosocomial infections. Antibiotic regimens confirmed to improve local fracture outcomes in such studies could then be used rationally, balancing the risks of local fracture-related infections and of multi-drug-resistant systemic infections to achieve optimal global outcomes.

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Open fractures of the tibia in children

Cited by 107 publications

References 4 publications

Complications After Titanium Elastic Nailing of Pediatric Tibial Fractures

Complications After Titanium Elastic Nailing of Pediatric Tibial Fractures

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

Prophylactic Antibiotic Use in Open Fractures: An Evidence-Based Guideline

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