The Orthopedic and Social Outcome of Open Tibia Fractures in Children

Abstract

To determine whether the accepted principles of management of open tibia fractures apply to children, 40 consecutive open fractures of the tibial shaft in skeletally immature patients were retrospectively reviewed. Attempts were made to evaluate the functional and social impact of open tibia fractures in children. All open fractures were initially treated by rapid irrigation and debridement which was repeated every 48 hours until soft tissues stabilized. The average age was 10.1 years and average follow up was 26 months (range: 1 8 to 84). There were 1 6 grade I, ? 0 grade II, and 1 4 grade III open fractures. The grade III fractures were further subdivided into 6 grade HlA, 7 grade IHB, and 1 grade UIC. The average time to union was 7.5 and 1 1 .0 weeks in the grade I and Il fractures respectively, with no infections and no delayed unions. In grade III fractures, the average time to union was 15 weeks, with 1 infection and 3 delayed unions. Bone grafting using autogenous iliac crest was performed on 2 patients. The children surveyed missed an average of 4.1 months of school and 33% had to repeat a year. Twenty-five percent of the children complained of nightmares involving the events of the accident. Chronic pain despite solid union was found in 30% of patients. Forty percent of those surveyed (7 grade III fractures) complained of a limp. The low incidence of soft tissue complications and infections in the study population supports applying in children the same basic soft tissue management principles of open fracture treatment as used in adults. While bone stabilization options are limited in children, the rate of successful union without adjunctive bone grafting is much higher than that of adults treated under similar protocols. Routine early iliac crest bone grafting is unnecessary. The prevalence of gait abnormality despite fracture union should be taken into account during the patient's rehabilitation. The extensive time missed from school and resulting scholastic setback should not be underestimated.

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

“…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].…”

“…We identified 61 articles from our search of the databases: 30 from PubMed [1, 11, 15–42], six from Cochrane [43–48], and 25 from EMBASE [4–7, 9, 11, 31, 37, 49–65]. Three of these studies were found in both the PubMed and EMBASE databases [11, 31, 37].…”

“…We identified 61 articles from our search of the databases: 30 from PubMed [1, 11, 15–42], six from Cochrane [43–48], and 25 from EMBASE [4–7, 9, 11, 31, 37, 49–65]. Three of these studies were found in both the PubMed and EMBASE databases [11, 31, 37]. Twenty-two studies [21, 23, 24, 31–35, 38, 39, 41, 46, 51, 52, 54–56, 58–61, 64] were excluded because they reported closed tibia fractures exclusively or in addition to open tibia fractures, and not enough data was supplied to analyze the open tibia fractures separately.…”

“…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. In those studies that had average follow-up information (nine studies, n = 435), the frequency weighted mean follow up was 18.9 months (range 1–150 months) [1–6, 9, 11–13]. Frequency weighted mean union (defined by clinical, radiological, or both criteria) rates for all tibia fractures was 14.6 weeks (range 9.1–21.0 weeks).…”

Educational support needs of injured children and their families after a child’s traumatic injury: A qualitative study

“…Although survival has improved, rehabilitation and functional outcomes, such as injured children’s return to school have received less attention. The wide range of injuries managed in Major Trauma Centres often result in immediate, and sometimes prolonged, disruption to the injured child’s education, ( 2 , 3 ), which can adversely affect their academic attainment ( 4 , 5 ). It is important for health and education professionals to support injured children’s timely return to education and minimize any negative impacts ( 5 ).…”