Abstract
Introduction: A review of the treatment of 33 open fractures in 29 children over the period 1997 to 2002.
Method: Intravenous antibiotics, debridement and wound irrigation was performed prior to skeletal stabilisation incorporating plaster cast immobilisation (4%), K wire fixation (13%), screw fixation (13%), flexible intramedullary nail fixation (13%) and external fixation (57%). Secondary wound closure was undertaken if appropriate at 48 hours. The tibia was involved in 49% of cases with approximately equal distribution of other long bone extremities. Fractures were classified according to Gustilo et al (22% grade I, 26% grade II, 17% grade III and 35% grade IIIb).
Results: The average age was 10 years in 22 boys and 7 girls. Tibial fracture union was an average of 9 weeks in gradeI and II compared with 20 weeks for grade III. The remaining fractures healed at an average of 10 weeks. Non union occurred in one patient (tibia). There was on case of growth arrest of the distal tibia. There were no cases of osteomyelitis.
Discussion: Open fractures in children most often result from high energy trauma. An increase in fracture and soft tissue severity is associated with a delayed union. Physeal injuries require close observation for potential growth arrest.
Correspondence should be addressed to BSCOS, c/o Royal College of Surgeons, 35 – 43 Lincoln’s Inn Fields, London, WC2A 3PN
