open fractures in children

8/3/2019 Open Fractures in Children

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Dr. Vrisha MadhuriProf. & Head

Department Of Pediatric Orthopedics

Christian Medical College

Vellore, INDIA

Dr. Rahim HamidFellow Paediatric Ortho


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An open fracture is one in which a break in the skinand underlying soft tissues leads directly into orcommunicates with the fracture and the hematoma.

Open fractures in children have been reported toheal with few complications in a time frame similarto that for closed fractures.

The purpose of the present retrospective study wasto analyze the results and complications oftreatment associated with open fractures in

children.


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156 children (27 girls and 129 boys) with 175fractures(2006-2011)

Average age 10.6 3.7years(range2 to 18)

82(52.5%)patients had fracture due to Road trafficaccident ,18(11.5%) had fall from bicycle 25(16%)had fall from height, 17(10.8%) had fall from tree,9(5.7%) had fall in to well and 5(3.2%) had others

miscellaneous reasons e.g. trapped in the machine. The average time from injury to hospital arrival in all

children was 135 40minutes (range 60 to 600).

The mean time for all children for first antibiotic was

233.6 50mins (60 to 720)


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39(22.2%) fractures were Gastillo Anderson typeI, 49(28%) fractures were type II, 30(17.1%) were

IIIa, 47(26.8%) were IIIb and 9(5.1%) were IIIc.

Fracture Number (percentage)

Humerus 6(3.4%)

Supracondylar 15(8.5%)

Fracture around elbow 8(3.5%)

Both bone forearm 24(13.6)

Distal Radius 18(10.2%)

Femur 21(10.8%)

Tibia 52(29.7%)

Ankle and foot 29(16.5%)

Open injuries around knee 4(2.2%)


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The average Pediatric Trauma Score was 7.5(Range 4 to 9).

The average time from arrival to surgery was 219minutes (4.65hrs).

30(19.2%) patients were treated with debridement andcast.

126(81.8%) were managed by debridement and fixation

(internal, external or combined). 2 patients needed bone grafting for non-union.

Guistilo

Anderson1 2 3a 3b 3c

Union

Time/week

6.92.1

(4 to 16)wks

8.8 5.5

(3.5 -52) wks

12.78 6.4

(5 36) wks

9.51 6.4

(3 25)wks

8.35.6

(4 16) wks

Soft tissueProcedure

PrimaryClosure STSG FLAP

SecondaryClosure

Number 30 30 11 10


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Treatment Cast K wire Flexible nail Ext fix ScrewCombined

Patients30 39 13 36 15 23

Infected 0 5 0 8 2 1

16(10.2%) patients developed infection out which 4(2.55%) had

superficial and 12(7.57%) had bone infection. The time from injury to surgery in patients with infection

was 31963mins while in other group it was 23359mins and

the average time to from injury to arrival and injury to first

antibiotic was almost same in both groups. GA type 1 fractures had no infection, 2/49 children with GA

type II, 5/30 children with GA 3a, 7 /47 with GA 3b and 2/9with 3c had infections.

Distal radius fracture 8/18(44.4%) are the most common

in infected group.


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Most open fractures in children can be managedwith minimal complications.

Complications of open fractures in children

increase with time delay in the debridement andcomplexity of the injury.

Early Debridement and fixation results in better

outcome.

Soft tissue management is better necessitate less

complex flap coverage as compared to adults.

open fractures in children

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