Type III open tibial fractures in children

Abstract

The management of open tibial fractures in children differs from that in adult patients. We present a retrospective study of Type III open fractures of the tibia in children treated in our facility.A total of 16 Type III open fractures of the tibia were retrospectively studied. Of the 16 fractures, 11 were Type IIIA fractures, three Type IIIB, and two Type IIIC, according to the classification of Gustilo et al. The average age of the patients was 7 years and 5 months (range, 4 to 13 years). Nine fractures were initially stabilized by external fixation, one by pinning, and six by external immobilization. The average follow-up period was 4 years.Infection occurred in four patients (two superficial and two “deep” infections). Three infections were successfully treated with antibiotics, re-debridement, split-thickness skin graft, and local skin flap. However, one Type IIIC fracture with osteomyelitis required an amputation because of circulatory failure associated with infection. The average time to union was 13.3 weeks (range 7 to 24 weeks). One defective nonunion was observed, and was treated by tibio-fibular synostosis. Three fractures healed with angular deformity of more than 10 degrees at the time of union. However, spontaneous correction and remodeling of the bone resulted in deformities of 10 degrees or less. Unfortunately, both of the Type IIIC fractures ultimately required secondary amputation.Overall, with the exception of one type IIIB case requiring tibio-fibular synostosis and two type IIIC cases needing amputations, the cases should positive outcomes. Aggressive wound irrigation and appropriate fracture management during initial treatment would prevent the complications of Type III open fractures in children.