The Journal of Bone and Joint Surgery, Vol 72, Issue 10 1462-1469, Copyright © 1990 by Journal of Bone and Joint Surgery, Inc
Open fractures of the tibia in children
SL Buckley, G Smith, PD Sponseller, JD Thompson and PP Griffin
Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, Maryland 21205.
Forty-one children who had forty-two open fractures of the tibial
metaphysis or diaphysis were studied retrospectively. Twelve fractures were
Type I; eighteen, Type II; six, Type IIIA; four, Type IIIB; and two, Type
IIIC, according to the classification of Gustilo et al. All fractures were
irrigated and debrided, and antibiotics were given for a minimum of
forty-eight hours after the injury. Twenty fractures were initially treated
with external fixation and twenty-two, with immobilization in a plaster
cast. Three patients had an early infection of the wound, one of which was
associated with osteomyelitis; all were successfully treated. The average
time to healing of the fracture was five months (range, two to twenty-one
months). The time to union was related to the severity of the soft-tissue
injury, the pattern of the fracture, the amount of segmental bone loss, the
occurrence of infection, and the use of external fixation. There were six
delayed unions. Four patients had an angular malunion of more than 10
degrees, which spontaneously corrected in three. One patient who had a
proximal metaphyseal-diaphyseal segmental fracture had a progressive valgus
deformity. Four patients who had a severe fracture that was treated with
external fixation had more than one centimeter of tibial over-growth. There
were no amputations. The incidences of compartment syndrome, vascular
injury, infection, and delayed union were similar to those reported for
open tibial fractures in adults.
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