The orthopedic and social outcome of open tibia fractures in children
Insights
Pediatric open tibia fractures can be managed using adult principles, with good bone union rates. However, long-term functional and social impacts, including school absence and chronic pain, require careful consideration during rehabilitation.
Area of Science:
- Orthopedic Surgery
- Pediatric Traumatology
- Reconstructive Surgery
Background:
- Open tibia fractures in children require specific management considerations.
- Assessing the long-term functional and social outcomes is crucial for pediatric patients.
Purpose of the Study:
- To evaluate the applicability of adult open fracture management principles to pediatric tibial shaft fractures.
- To assess the functional and social impact of open tibia fractures in skeletally immature patients.
Main Methods:
- Retrospective review of 40 consecutive open tibia fractures in children.
- Initial treatment involved rapid irrigation and debridement, repeated until soft tissue stabilization.
- Fracture severity was graded (I, II, III), with follow-up averaging 26 months.
Main Results:
- Grade I and II fractures showed excellent union (7.5-11 weeks) with no infections or delayed unions.
- Grade III fractures had a longer union time (15 weeks), with 1 infection and 3 delayed unions.
- Significant social and functional impacts observed: average 4.1 months school absence, 33% repeating a year, 30% chronic pain, 40% limp.
Conclusions:
- Standard adult soft tissue management principles are effective for pediatric open tibia fractures.
- Children exhibit higher rates of successful bone union without early bone grafting compared to adults.
- Rehabilitation must address gait abnormalities and the substantial psychosocial impact, including scholastic setbacks.
Abstract:
To determine whether the accepted principles of management of open tibia fractures apply to children, 40 consecutive open fractures of the tibial shaft in skeletally immature patients were retrospectively reviewed. Attempts were made to evaluate the functional and social impact of open tibia fractures in children. All open fractures were initially treated by rapid irrigation and debridement which was repeated every 48 hours until soft tissues stabilized. The average age was 10.1 years and average follow up was 26 months (range: 18 to 84). There were 16 grade I, 10 grade II, and 14 grade III open fractures. The grade III fractures were further subdivided into 6 grade IIIA, 7 grade IIIB, and 1 grade IIIC. The average time to union was 7.5 and 11.0 weeks in the grade I and II fractures respectively, with no infections and no delayed unions. In grade III fractures, the average time to union was 15 weeks, with 1 infection and 3 delayed unions. Bone grafting using autogenous iliac crest was performed on 2 patients. The children surveyed missed an average of 4.1 months of school and 33% had to repeat a year. Twenty-five percent of the children complained of nightmares involving the events of the accident. Chronic pain despite solid union was found in 30% of patients. Forty percent of those surveyed (7 grade III fractures) complained of a limp. The low incidence of soft tissue complications and infections in the study population supports applying in children the same basic soft tissue management principles of open fracture treatment as used in adults. While bone stabilization options are limited in children, the rate of successful union without adjunctive bone grafting is much higher than that of adults treated under similar protocols. Routine early iliac crest bone grafting is unnecessary. The prevalence of gait abnormality despite fracture union should be taken into account during the patient's rehabilitation. The extensive time missed from school and resulting scholastic setback should not be underestimated.
