Open tibial fractures in children under 13 years of age—10 years experience

Abstract

Objective: To evaluate the results of treatment in children with open tibial fractures. Design: Retrospective review. Subjects: Eighty three children under 13 years of age treated for an open tibial fracture between 1989 and 1999. Main outcome measures: Patient demographics, mechanism of injury, fracture classification, treatment method, clinical outcome and complications. Results: Eighty one percent of children had an open tibial fracture as their only injury. According to the level of contamination, soft tissue injury and size of wound 46% were Gustilo grade I injuries, 30% grade II, and 22% (18) grade III (6 IIIa, 5 IIIb, 3 IIIc and 4 not otherwise specified). Sixteen fractures (19%) were treated using an external fixator and 65 (78%) using a cast. The average time to union was 15.5 weeks (range 9–31 weeks) for those treated with a frame and 10.4 weeks (range 5–40 weeks) for those treated with a cast. No deep infections, one delayed union and one non-union were recorded. Conclusions: Ninety four percent of these injuries were a result of a motor vehicle accident and involved a significant trauma-related energy transfer. Despite this the associated morbidity was low lending support to the literature, which suggests that open fractures of the tibia in younger children heal more predictably and with less complications than those occurring in adolescents or adults.