Paediatric type I open tibia fractures: are antibiotics alone sufficient?

Area of Science:

• Orthopedic Surgery
• Pediatric Trauma
• Infectious Disease

Background:

• Conventional management of open fractures includes emergent debridement.
• Evidence suggests questioning this approach for pediatric Gustilo-Anderson type I open fractures.

Purpose of the Study:

• To systematically review infection rates comparing nonoperative management (antibiotics) versus operative debridement.
• Focus on pediatric type I open lower limb tibial fractures without need for surgical fixation.

Main Methods:

• Systematic review adhering to PRISMA guidelines.
• Included patients under 18 with type I open tibia fractures.
• Excluded polytrauma and those needing operative stabilization.
• Assessed bias using ROBINS-I tool.

Main Results:

• Ten retrospective studies (123 patients) were analyzed.
• Nonoperative group (41 patients): 4.87% infection rate (2/41).
• Operative debridement group (82 patients): 2.33% infection rate (2/82).

Conclusions:

• Optimal management for pediatric type I open tibia fractures remains unclear.
• Selected low-energy injuries may be managed nonoperatively in the emergency department.
• Insufficient high-quality evidence to routinely deviate from current guidelines; consider energy absorption.