Open Reduction of Closed Pediatric Tibial Shaft Fractures Treated With Intramedullary Stabilization Does Not Increase Risk of Postoperative Complications.

Abstract

To compare union and complication rates in pediatric patients presenting with tibial shaft fractures treated with closed or open reduction before intramedullary stabilization. Retrospective review. Multiple pediatric trauma centers. Pediatric patients presenting with tibial shaft fractures treated with intramedullary stabilization. Intramedullary stabilization after closed or open reduction (percutaneous and open approach). Union rates, infection rate (superficial and deep), and unplanned return to the operating room (OR). One hundred sixty-six patients were included in this study. One hundred thirty-six patients presented with closed fractures, and 30 patients presented with open tibial shaft fractures. Thirty-seven of the 136 patients (27%) with closed fractures had their fracture specifically opened during surgical fixation. There was no statistical difference in radiographic union at 6 months between fractures electively opened and those treated with closed reduction alone 97% versus 98% (P = 0.9). No patient who underwent an open reduction developed infections or wound-healing concerns, whereas 2 of the 99 (2%) patients treated closed had superficial surgical site infections requiring additional treatment (P = 0.999). There was no difference in unplanned return to OR between those who underwent open reduction at the time of intramedullary stabilization (P = 0.568). Performing an open reduction in a closed pediatric tibial shaft fracture before intramedullary fixation does not increase the risk of surgical site infections or wound issues, delayed union, or unplanned return to the OR. An open reduction of a closed tibial shaft fracture for purposes of improving a reduction before intramedullary stabilization may be a safe and effective clinical practice. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.