title: Open tibial fractures in the paediatric population: a systematic review of the literature.
abstract: BACKGROUND
  Open tibial fractures have been studied extensively in adults, and detailed treatment strategies have been developed: wound irrigation and debridement, fracture stabilization and delayed primary wound closure or early flap coverage are basic principles of management. No clear guidelines regarding the management of open tibial fractures in children exist.
  
  
  METHODS
  We searched Medline, Embase, Cochrane, CINAHL and Google Scholar databases using the keywords: 'open', 'tibia', 'fracture', 'children', 'paediatric', 'pediatric', 'external fixation', 'nailing'. Fourteen clinical studies were included. Quality of the studies was assessed using the Coleman Methodology Score.
  
  
  RESULTS
  Age above 10 years and grade III (severe) open fractures are associated with complications and outcomes similar to those in adults.
  
  
  RESULTS
  It is unclear whether open fractures of the tibia in children should be managed according to the principles followed in adults. Many authors support primary skin closure and non-operative management for grade I open fractures. There is no clear effect of fracture fixation method on time to union.
  
  
  CONCLUSIONS
  The quality of the studies was relatively poor. Patients' age affects outcome; adolescents should probably be managed as adults.
  
  
  CONCLUSIONS
  Carefully designed prospective cohort studies including a large number of children would be of value. Adequate follow-up is necessary to assess the long-term effects in the growing skeleton. The efficacy of flexible intramedullary nailing for open fractures needs further evaluation. Outcome studies based on general health measures are needed.
authors.affiliation: Centre for Sports and Exercise Medicine Barts and The London School of Medicine and Dentistry, Mile End Hospital, London, UK.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Gougoulias
authors.forename: Anil
authors.initials: A
authors.lastname: Khanna
authors.forename: Nicola
authors.initials: N
authors.lastname: Maffulli
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005592:Fracture Fixation / Q000379:methods; D017102:Fracture Healing; D005597:Fractures, Open / Q000150:complications / Q000601:surgery*; D006801:Humans; D008297:Male; D012107:Research Design / Q000592:standards; D013978:Tibial Fractures / Q000150:complications / Q000601:surgery*; D016896:Treatment Outcome