Open Gustilo 1 and 2 midshaft fractures of the radius and ulna in children: is there a role for cast immobilization after wound debridement?
BACKGROUND
Open fractures of the forearm in children are one of the indications for open reduction and internal fixation. Fixation allows for soft tissue management and maintenance of reduction. This study compares the outcome of open Gustilo 1 and 2 midshaft forearm fractures treated with cast immobilization versus the outcome of those treated with internal fixation after wound debridement.


METHODS
This is a retrospective study of the cases of 31 children treated in Kandang Kerbau Women's and Children's Hospital from 1998 to 2005. All had wound debridement, followed by cast immobilization in 15 patients and implant stabilization in 16 others, using plates and screws or intramedullary K-wires. The patients were assessed at final follow-up using the classification by Price.


RESULTS
Both treatment groups had 100% excellent or good results. There was no significant difference in time to union. However, there was a higher incidence rate of delayed union and infection when treated with implant stabilization. The main complication associated with cast immobilization was loss of reduction (4 cases), of which 1 case required a second manipulation.


CONCLUSIONS
Despite the trend toward implant stabilization of all open forearm fractures, this study shows that there is still a role for cast immobilization in its treatment of Gustilo 1 and 2 open forearm fractures as long as proper casting technique and close follow-up is achieved. However, internal fixation should be considered in cases where the fracture is noted intraoperatively to be unstable or if attempted reduction fails, bearing in mind the possible complications associated with internal fixation.
Lim
Yi-Jia
YJ
Department of Orthopaedic Surgery, Kandang Kerbau Women's and Children's Hospital, Singapore. lim.yi.jia@singhealth.com.sg
Lam
Khee Sien
KS
Lee
Eng Hin
EH
D000293:Adolescent; D002370:Casts, Surgical; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003646:Debridement; D005260:Female; D005592:Fracture Fixation / Q000379:methods*; D005593:Fracture Fixation, Internal / Q000379:methods; D017102:Fracture Healing; D005597:Fractures, Open / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D007103:Immobilization / Q000379:methods; D008297:Male; D011859:Radiography; D011885:Radius Fractures / Q000000981:diagnostic imaging / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014458:Ulna Fractures / Q000000981:diagnostic imaging / Q000628:therapy*