Casting versus surgical fixation for grade IIIA open tibial diaphysial fractures in children: effect on the rate of infection and the need for secondary surgical procedures to promote bone union

Abstract

We evaluated 39 grade IIIA open tibial fractures presenting in children younger than 13 years of age, to determine if the mode of fracture stabilization (casting vs. surgical fixation) was related to the rate of infection or the need for secondary surgical procedures to promote bone union. All fractures had wound debridement in the operating room. Thirty patients had manipulation and casting, and nine surgical internal or external fixation. There were two cases of infection in the cast-treated group and two in the surgical fixation group (P=0.17). None of the fractures required a secondary surgical procedure to promote bone union. Three of the fractures treated by manipulation and casting displaced; two required re-manipulation and casting and one was converted to external fixation. In two cases the applied external fixator had to be re-aligned. Our results suggest that manipulation and casting is a reliable treatment for open tibial fractures in children.Résumé Nous avons évalué 39 fractures tibiales ouvertes niveau IIIA survenues chez des enfants de moins de 13 ans, pour déterminer si le mode de stabilisation de la fracture (plâtre contre fixation chirurgicale) a été en rapport avec le taux d'infection ou la nécessité d'interventions chirurgicales secondaires pour obtenir la consolidation. Toutes les fractures avaient un parage en salle d'opération. Trente malades avaient une réduction suivie d'un plâtre, et neuf une fixation chirurgicale interne ou externe. Il y avait deux cas d'infection dans le groupe traité par plâtre et deux dans le groupe fixation chirurgicale (P=0,17). Aucun des fractures n'a nécessité une intervention chirurgicale. Trois fractures traitées par plâtre se sont déplacées, avec nouvelle réduction et plâtre pour deux, et utilisation d'un fixateur externe pour la troisième. Dans deux cas les fixateurs externes ont du être réalignés. Nos résultats suggèrent que le traitement orthopédique par réduction et plâtre est un traitement fiable pour les fractures tibiales ouvertes chez les enfants.

External fixation versus elastic stable intramedullary nailing in the treatment of open tibial shaft fractures in children

“…However, the malunion rate was not meticulously measured and analyzed. In another study reported by Charalambous et al in 2005 [ 7 ], 30 patients had manipulation and casting, and 9 patients had surgical internal or external fixation. There were 2 cases of infection in the cast-treated group and 2 in the surgical fixation group ( P = 0.17).…”

“…However, for some fractures such as comminuted or unstable fractures, open fractures, and polytrauma, surgical stabilization is usually warranted [ 4 – 6 ]. Although Charalambous et al reported debridement followed by casting vs. surgical fixation [ 7 ], utilization of external fixator (EF) remains a popular choice for open injuries. However, pin tract infection (PTI) and refracture are common complications during the application of EF [ 8 , 9 ].…”

Operative Choice for Open Tibial Shaft Fracture in Children: A Comparative Study of External Fixator Vs. Elastic Stable Intramedullary Nail

“…Still certain authors recommended manipulation followed by casting for open tibial fractures in children without the necessity of vascular reconstruction [15]. However, the malunion rate was not meticulously measured and analyzed [7,15]. Besides, the surgical stabilization for earlier mobilization and better alignment was gaining popularity recently [16].Therefore, for GA II and IIIA tibial shaft fracture, surgical stabilization was adopted in our hospital.…”

“…However, in situations like comminuted or unstable fractures, open fractures and polytrauma, surgical stabilization is usually warranted [4][5][6]. Although debridement followed by casting has been reported [7], external xator (EF) is a preferred choice for open injuries. However, pin tract infection (PTI) and refracture are common complications during the application of EF [8,9].…”