Soft Iissue management of children's open tibial fractures - A review of senventy children over twenty years

P. Rao, M. V. Schaverien, K. J. Stewart

Research output: Contribution to journalReview articlepeer-review

16 Scopus citations

Abstract

INTRODUTION The management of open tibial fractures in children represents a unique reconstructive challenge. The aim of the study was to evaluted the management of paediatric open tibial fractures with particular regard to soft tissue management. PATIENTS AND METHODS A retrospective case-note analysis was performed for all children presenting with an open tibial fracture at a single institution over a 20-year period for 1985 to 2005. RESULTS Seventy children were reviewed of whom 41 were males and 29 females, Overall, 91%(n=64) of children suffered thir injury as a result of a vehicle-related injury. The severity of the fracture with respect to the Gustilo classification was: Grade I, 42%(n=29); Grade II, 24%(n=17); Grade III, 34%(n=24;7 Grade 3a, 16 Grade 3d, 1 Grade 3c). The majority of children were treated with external fixation and conservative measures, with a mean hospital in-patient stay of 13.3 days. Soft tissue cover was provided by plastic surgeons in 31% of all cases. Four cases of superficial wound infection occurred(6%), one case of osteomyelities and one case of flap failure. The limb salvage was greater than 98%. CONCLUSIONS In this series, complications were associated with delayed involvement of plastic surgeons. Retrospective analysis has shown a decreased incidence of open tibial fractures which is reported in similar studies. Gustilo grade was found to correlate with length of hospital admission and plastic surgery intervention. We advocate, when feasible, the use of local fasciocutaneous flaps (such as distally based fasciocutaneous and adipofascial flaps), which showed a low complication rate in children.

Original languageEnglish (US)
Pages (from-to)320-325
Number of pages6
JournalAnnals of the Royal College of Surgeons of England
Volume92
Issue number4
DOIs
StatePublished - May 2010
Externally publishedYes

Keywords

  • Children
  • Fasciocutaneous flaps
  • Open tibial fracture
  • Soft tissue management

ASJC Scopus subject areas

  • Surgery

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