Open Fractures of the Tibia in Children

Grimard, Guy; Naudie, Douglas; Laberge, Louise Caouette

doi:10.1097/01241398-199705000-00067

Cited by 3 publications

(6 citation statements)

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“…There are no other non-union rates published in the literature apart from a handful of case series and those looking at particular anatomical sites [3][4][5].…”

Section: Discussionmentioning

confidence: 99%

“…Lewallen et al [8] published a series of 30 paediatric non-unions over a 10 year period with a male lower limb predominance, peaking at 13 years of age. However none of these studies were able to compare their non-union numbers to their population size or fracture [3,4] have suggested that non-union risk was related to increasing age and did not occur in the under 6 year old age group. In our study the 0-4 year age group had the lowest number of non-unions, 31 (within which 5 were tibial) over a 5 year period in a 276,164 population of 0-4 year olds, however the incidence of fracture was also very low in that population group resulting in a similar risk of non-union per fracture to those up to the age of 15.…”

Section: Discussionmentioning

confidence: 99%

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The risk of non-union per fracture in children

Mills

Simpson

2013

Journal of Children's Orthopaedics

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Background Non-union in children is considered a rare but real complication of fracture management; however there is no information available in the literature regarding its incidence. The aim of this work was to investigate the incidence of fractures and non-union in children for different anatomical regions/age groups, and for the first time to publish data regarding the rate of non-union per fracture in children in a large population. Method Prospective data for all hospital admissions for paediatric fractures and paediatric fracture non-union in Scotland between 2005 and 2010 was obtained. Regional data for total paediatric fracture numbers was also available enabling total fracture numbers and non-union incidence at a national level to be calculated. Results There were 180 non-unions in the 0-14 year olds and 242 non-unions in 15-19 year olds recorded over 5 years in a population of 1.2 million children (0-19 years). The number of fractures during this time period for the same age groups were 92,200 and 68,900 respectively. The risk of fracture increased steadily with age; it was greater in boys than girls and far higher in the upper than lower limb. The overall rate of non-union per fracture was 0.

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“…There are no other non-union rates published in the literature apart from a handful of case series and those looking at particular anatomical sites [3][4][5].…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The risk of non-union per fracture in children

Mills

Simpson

2013

Journal of Children's Orthopaedics

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“…There have been reports in the literature of open tibial fractures in children, successfully treated with wound debridement and immobilization in a cast [1][2][3][5][6][7]. Bartlett et al [1] studied 23 open tibial fractures in children aged 3.5-14.5 years, eight of which were grade IIIA.…”

Section: Discussionmentioning

confidence: 99%

“…Grimard et al [3] looked at 90 open tibial fractures, 14 of which were grade IIIA. Forty were stabilised in a cast, 31 with external and 18 with internal fixation.…”

Section: Discussionmentioning

confidence: 99%

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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

Charalambous

Alvi

Siddique

et al. 2005

International Orthopaedics (SICO

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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.

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Use of a “kickstand” modification for external fixation of lower extremity fractures in children

Sawyer

Kelly

Rhodes

et al. 2011

Journal of Children's Orthopaedics

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Purpose To evaluate and describe the kickstand modification and its use in children with lower extremity fractures. Methods Retrospective review identified eight children in whom the kickstand technique was used during treatment of their lower extremity fractures. The seven boys and one girl had a mean age of 11.8 years. All fractures were caused by high-energy trauma. Five of the eight tibial fractures were open fractures (one type 1, one type 2, and three type 3B), and five of the eight patients had multiple extremity fractures. Results Additional procedures were required in six of the eight children, four of whom had multiple lower extremity fractures. No additional pressure-relieving modalities were used in any patient. The kickstand did not affect the fracture reduction, prevent patient mobilization, or require operative adjustment in any patient, and none had any skin pressure-related complications on the heel of the affected extremity. Conclusion In pediatric patients with lower extremity trauma, the addition of a kickstand to the external fixator provides a simple, inexpensive, lightweight, adjustable, and adaptable method for encouraging elevation of the injured extremity, which facilitates edema control; it also allows easy neurovascular monitoring and wound care.

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Open Fractures of the Tibia in Children

Cited by 3 publications

References 0 publications

The risk of non-union per fracture in children

The risk of non-union per fracture in children

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

Use of a “kickstand” modification for external fixation of lower extremity fractures in children

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