Comparison of nonoperative versus operative management in pediatric gustilo-anderson type I open tibia fractures

Background: Recent studies suggest pediatric Gustilo-Anderson type I fractures, especially of the up-per extremity, may be adequately treated without formal operative debridement, though few tibial frac-tures have been included in these studies. The purpose of this study is to provide initial data suggesting whether Gustilo-Anderson type I tibia fractures may be safely treated nonoperatively.Methods: Institutional retrospective review was performed for children with type I tibial fractures man-aged with and without operative debridement from 1999 through 2020. Incomplete follow-up, poly -trauma, and delayed diagnosis of greater than 12 h since the time of injury were criteria for exclu-sion. Data including age, sex, mechanism of injury, management, time-to-antibiotic administration, and complications were recorded.Results: Thirty-three patients met inclusion criteria and were followed to union. Average age was 9.9 +/- 3.7 years. All patients were evaluated in the emergency department and received intravenous antibiotics within 8 h of presentation. Median time-to-antibiotics was 2 h. All patients received cefa-zolin except one who received clindamycin at an outside hospital and subsequent cephalexin. Three patients (8.8%) received augmentation with gentamicin. Twenty-one patients (63.6%) underwent opera-tive irrigation and debridement (I&D), and of those, sixteen underwent surgical fixation of their frac-ture. Twelve (36.4%) patients had bedside I&D with saline under conscious sedation, with one requiring subsequent operative I&D and intramedullary nailing. Three infections (14.3%) occurred in the operative group and none in the nonoperative group. Complications among the nonoperative patients include de-layed union (8.3%), angulation (8.3%), and refracture (8.3%). Complications among the operative patients include delayed union (9.5%), angulation (14.3%), and one patient experienced both (4.8%). Other opera-tive group complications include leg-length discrepancy (4.8%), heterotopic ossification (4.8%), and symp-tomatic hardware (4.8%).Conclusion: No infections were observed in a small group of children with type I tibia fractures treated with bedside debridement and antibiotics, and similar non-infectious complication rates were observed relative to operative debridement. This study provides initial data that suggests nonoperative manage-ment of type I tibial fractures may be safe and supports the development of larger studies.(c) 2022 Elsevier Ltd. All rights reserved.