Open tibial fractures. Are children small adults?
Open tibial fractures in adults have been extensively studied. In children, however, only a small number of case series provide data on management and outcome of these injuries. It is not clear whether open tibial fractures in children 'behave' in a similar fashion to those in adults, and clear guidelines regarding their management do not exist. Primary wound closure after irrigation does not increase infection rates in low grade open tibial fractures. Cast is an effective method for fracture stabilization in stable fractures. External fixation is usually used in patients with significant soft tissue injury, and elastic intramedullary nailing is an alternative. Age over 10 years and open fracture grade III appear to be significant prognostic factors. Complication rates are not unremarkable and long-term studies are required to investigate their consequences. Children over 10 years should probably be managed as adults. Further research is needed to evaluate the effectiveness of different fracture management methods.
Gougoulias
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University Hospital of North Staffordshire, Stoke on Trent, UK. gougnik@yahoo.com
Khanna
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A
Maffulin
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