Abstract
In this article, we report a case series on spanning external fixation for the treatment of open joint burn injuries in a pediatric population. We reviewed the case logs of all orthopedic surgeons from 2000 to 2010 at a burn hospital to identify pediatric patients with open joints secondary to burn injuries.Nine patients who sustained open joint injuries after a burn and treated with a spanning external fixator (SEF) were identified. Characteristics of the burns included: five elbow, four knee; seven flame, two electrical; average total body surface area affected 49.4% (range 25%–79%); substantial third-degree burn in all patients. Average age at the time of the burn was 8.6 years (range: 2 months–17.9 years). Average time from the burn to SEF placement was 7.1 weeks (range: 3–10.5 weeks). Before SEF placement, an average of 3.8 skin grafting procedures (range: 1–7) were performed to treat the open joint injuries. SEFs remained in place for an average of 6.4 weeks (range: 3–9 weeks). After SEF application, skin graft procedures were performed on average 0.6 times (range: 0–3). There were two complications (22%) considered to be directly associated with the SEF procedure due to the failure of fixation.Placement of an SEF for an open joint burn injury in children is an effective means to treat these uncommon and difficult injuries. We recommend early SEF to help assist with soft tissue healing and decrease the number of skin grafting procedures in this population.
Highlights
Skeletal immobilization is one of the oldest and most used treatment modalities for the trauma patient
Burn care has evolved from early skeletal traction with full body elevation and delayed surgical care [1]
Excision with skin graft application decreases the amount of soft tissue-induced contracture deformity with eventual improved functional recovery [2,3]
Summary
Skeletal immobilization is one of the oldest and most used treatment modalities for the trauma patient. The patient required no additional skin grafting procedures to his right elbow after SEF placement He had a 10-month follow-up after the injury and his PT/OT notes documented a final ROM of 30–110° in the extension and flexion arc, supination of 30° and pronation WNL, and a 5/5 motor strength. The patient required three additional skin grafting procedures to his right elbow after SEF placement He had a 12-month follow-up after the injury and his PT/OT notes reported a final ROM of 0°– 110° in the extension and flexion arc, supination of 30°, and pronation 70°. The patient required no additional skin grafting procedures to his left knee after SEF placement He had a 10-month follow-up after the injury and his PT/OT notes recorded a final ROM of 0°–45° in the extension and flexion arc. The patient did develop some elbow stiffness and contracture at the time of SEF removal; her final ROM and strength are unknown
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