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A review of open tibia fractures in children
1Division of Orthopaedic Surgery, University of Washington, Seattle 98104, USA.
Insights
This retrospective study of pediatric open tibia fractures found that chest/abdominal injuries significantly increased mortality. Prompt surgery within 6 hours and avoiding neurovascular compromise are crucial for reducing infection and amputation risks in children.
Area of Science:
- Orthopedic Surgery
- Pediatric Trauma
- Clinical Outcomes Research
Background:
- Open tibia fractures in children present unique management challenges.
- Understanding risk factors for mortality, amputation, and infection is critical for improving patient outcomes.
Purpose of the Study:
- To retrospectively analyze outcomes of pediatric open tibia fractures.
- To identify significant factors influencing mortality, amputation rates, infection incidence, and time to union.
Main Methods:
- Retrospective review of 56 open tibia fractures in 55 children.
- Analysis of injury characteristics, treatment delays, and patient demographics.
- Statistical correlation of variables with outcomes such as fatality, amputation, infection, and union time.
Main Results:
- Overall case fatality rate was 7%, with chest/abdominal injuries being the most significant factor.
- Four amputations were performed; neurovascular compromise was a significant predictor (4/8 compromised extremities).
- Infection incidence was 14% (50% deep), with delays > 6 hours to surgery correlating with higher rates (25% vs 12%).
- Average time to union was 5 months; younger patient age was associated with longer union times.
Conclusions:
- Chest and abdominal injuries are critical determinants of mortality in pediatric open tibia fractures.
- Early surgical intervention (< 6 hours) and vigilant management of neurovascular status are essential to minimize complications.
- Patient age is a significant factor influencing fracture healing duration.
Abstract:
Fifty-six open tibia fractures in 55 children were studied retrospectively. The overall case fatality rate was 7% (four patients). The most significant factor affecting death rate was injury to the chest and abdomen. Four amputations were performed in four patients with five injuries. Statistically, the presence of neurovascular compromise was significant, with four of eight compromised extremities (in seven patients) requiring amputation. Infection occurred in eight injuries, for an incidence of 14% overall (50% deep). The most important variables were presence of neurovascular injury and delay in getting the patient to surgery. A delay of > 6 h was correlated with a 25% infection rate compared with a 12% rate for those operated on within 6 h. The average time to union was approximately 5 +/- 4 months (range, 1.5-24.8 months). The most significant factor affecting union time was the age of the patient.