Treatment of type II and type III open tibia fractures in children.
OBJECTIVE
To determine whether severe open tibial fractures in children behave like similar fractures in adults.


METHODS
A combined retrospective and prospective review evaluated treatment protocol for type II and type III open tibial fractures in children over a ten-year period from 1984 to 1993.


METHODS
Twenty-three fractures were studied in children aged 3.5 to 14.5 (18 boys and 5 girls). There were six type II, eight type IIIA, and nine type IIIB fractures. Type I fractures were not included. Seven fractures were comminuted with significant butterfly fragments or segmental patterns.


METHODS
Treatment consisted of adequate debridement of soft tissues, closure of dead space, and stabilization with external fixation. Bone debridement only included contaminated devitalized bone or devitalized bone without soft tissue coverage. Bone that could be covered despite periosteal stripping was preserved.


METHODS
Clinical and roentgenographic examinations were used to determine time to union.


RESULTS
All fractures in this series healed between eight and twenty-six weeks. Wound coverage included two flaps, three skin grafts, and two delayed primary closures. No bone grafts were required. There were no deep infections, growth arrests, or malunions. Follow-up has ranged from six months to four years.


CONCLUSIONS
Open tibia fractures in children differ from similar fractures in adults in the following ways: soft tissues have excellent healing capacity, devitalized bone that is not contaminated or exposed can be saved and will become incorporated, and external fixation can be maintained until the fracture has healed. Periosteum in young children can form bone even in the face of bone loss.
Bartlett
C S
CS
Orthopaedic Trauma Service, Hospital for Special Surgery, New York, New York, USA.
Weiner
L S
LS
Yang
E C
EC
D002648:Child; D002675:Child, Preschool; D003646:Debridement; D005260:Female; D018460:Fractures, Comminuted / Q000601:surgery; D005597:Fractures, Open / Q000601:surgery*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012189:Retrospective Studies; D013978:Tibial Fractures / Q000601:surgery*; D016896:Treatment Outcome