Open fractures of the tibia and femur in children

Forty-seven children with 32 open tibial fractures, 11 open femoral fractures, and six closed tibial fractures with compartment syndrome, which were surgically opened, were assessed for the time to union and incidence of nonunion and infection. Treatment varied with fracture severity and patient age. Tibial external fixators were supplemented by short-leg casts, and fixators were removed at an average of 7 weeks. No child required further surgery to achieve union. There was one (2%) delayed union and no nonunions. Three fractures (6%) developed infections. No pin-tract infections occurred in tibial fractures treated with external fixation with casting. The relation between age and time to union was statistically significant. In open fractures without segmental bone loss or soft-tissue loss requiring major reconstruction, bony healing can be expected within 6 months.