Results of the treatment of the open femoral shaft fractures in children

Abstract

Satisfactory results were obtained in all patients in terms of self evaluation of patients, radiological and clinical evaluation. The infection rate was much lower for patients who had been given a cephalosporin than for patient who had been given a penicillin or had been given no antibiotic.

Antibiotic Considerations in the Management of Pediatric Open Fractures

“…Each protocol included administration of a first-generation cephalosporin, typically Cefazolin, while one study used Amoxicillin/Clavulanic Acid (Table 1). 1,5,[17][18][19][20][24][25][26] Only two studies documented the time to administration of antibiotics (i.e., 292 minutes from injury 20 and less than 3 hours from presentation 26 ), while the remaining authors simply documented that antibiotics were administered promptly. 1,5,[17][18][19]24,25 Antibiotics were usually administered for 24 hours; however, two studies administered antibiotics for 48 hours 25,26 and three other studies had a proportion of patients (57% in Godfrey et al) who only received one dose.…”

“…1,5,[17][18][19][20][24][25][26] Only two studies documented the time to administration of antibiotics (i.e., 292 minutes from injury 20 and less than 3 hours from presentation 26 ), while the remaining authors simply documented that antibiotics were administered promptly. 1,5,[17][18][19]24,25 Antibiotics were usually administered for 24 hours; however, two studies administered antibiotics for 48 hours 25,26 and three other studies had a proportion of patients (57% in Godfrey et al) who only received one dose. 18,20,25 Three studies provided a 1 to 7-day course of antibiotics at discharge 19,25,26 while two studies did not prescribe oral antibiotics at discharge.…”

“…In six of the studies, administration of antibiotics was typically followed by irrigation and debridement (I&D) as well as closed reduction in the emergency room. [17][18][19][20]24,25 Two studies, including 377 patients, compared operative and nonoperative irrigation and debridement for open tibia and forearm fractures. 18,25 They found no difference in infection rates in the forearm (3% for operative vs. 0% for nonoperative) and tibia (0% for operative and 2% for nonoperative).…”

Pediatric Open Long-Bone Fracture and Subsequent Deep Infection Risk: The Importance of Early Hospital Care

“…In an attempt to optimize hospital course and reduce the risk of complications and infection following pediatric open fractures, different aspects of management have been empirically studied including: the initiation and duration of antibiotic treatment [ 13 , 14 ]; choice of antibiotics and the utility of preoperative cultures [ 13 , 14 , 15 , 16 ]; surgical approach for all fractures and nonoperative treatment for type I fractures [ 12 , 13 , 14 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 ]; time to operative debridement and irrigation [ 13 , 14 , 27 , 28 , 29 ]; the addition of negative pressure dressings [ 13 , 30 , 31 ]. Unfortunately, when compared to the management of open fractures in adults, high-level evidence is lacking, and most recommendations are based on case-series and/or historical standards of care [ 6 , 13 , 14 ].…”

Komplikationen und Komplikationsrisiken bei der Versorgung kindlicher Femurschaftfrakturen

“…Der Bruch führte vermutlich zu starkem Einbluten ins Gewebe, wo sich der Druck auf pathologische Werte erhöhte. In nur einer weiteren Studie (Sink et al 2005) wurde ein Kompartmentsyndrom nach einer ESIN-Behandlung verzeichnet.Über folgende weitere Komplikationen der ESIN-Behandlung wird in der Literatur berichtet: tiefe Wundinfektionen, Hautnekrose, Implantatbruch, Synovitis, neurologische Ausfälle, Refraktur, Osteomyelitis, Lungenembolie(Tomaszewski and Gap 2014; Bandyopadhyay und Mekherjee 2013;Lascombes et al 2006;Narayanan et al 2004;Moroz et al 2006;Buechsenschuetz et al 2002). Keine dieser Komplikationen trat im Krankengut dieser Arbeit auf.…”