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

被引:3
作者
Padgett, Anthony M. [1 ,4 ]
Torrez, Timothy W. [2 ]
Kothari, Ezan A. [1 ]
Conklin, Michael J. [1 ,3 ]
Williams, Kevin A. [1 ,3 ]
Gilbert, Shawn R. [1 ,3 ]
Ashley, Philip [1 ,3 ]
机构
[1] Univ Alabama Birmingham, Dept Orthopaed Surg, Birmingham, AL USA
[2] Univ Utah, Dept Orthopaed, Salt Lake City, UT USA
[3] Childrens Alabama, Div Orthoped Surg, Birmingham, AL USA
[4] Univ Alabama Birmingham, Heersink Sch Med, Dept Orthopaed Surg, 1600 7th Ave South,Lowder suite 316, Birmingham, AL 35233 USA
来源
INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED | 2023年 / 54卷 / 02期
关键词
Open fracture; Tibia; Pediatric; Nonoperative; Irrigation; Debridement; Antibiotics; EXTERNAL FIXATION; INFECTION; POPULATION; PREVENTION; CHILDREN; TRAUMA; DELAY;
D O I
10.1016/j.injury.2022.12.005
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
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.
引用
收藏
页码:552 / 556
页数:5
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