The results of treatment of 46 children with gravely open fractures were reviewed at the Orthopaedic and Traumatology Department of the Miguel Couto Emergency Hospital at Rio de Janeiro from 1990 through 1992. The tihia was fractured in 18 patients. Ages ranged between four and 12 years. Sixteen were boys and two were girls; nine white; nine black; 10 left leg; eight right leg. All injuries were incurred in automobile crashes. The lesion was isolated to the tibia in 15 of these patients. The other three children had associated trauma, two with cranial trauma and one with a compartment syndrome. The Gustillo classification (Type I, II, and III) was used. All fractures were treated initially with early irrigation and debridement, and were stabilized with screws, Kwirc, external fixation or cast. Complication occurred in four children as infection (two) and delayed union (two) that needed soft tissue coverage or bone graft. It is concluded that external fixation or K-wire stabilization had good results and that treatment of the complications was difficult and slow.
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