Initial management of pediatric Gustilo-Anderson type I upper limb open fractures: Are antibiotics enough?

IF 1.3 4区 医学 Q3 ORTHOPEDICS Journal of Childrens Orthopaedics Pub Date : 2024-08-27 eCollection Date: 2024-10-01 DOI:10.1177/18632521241262973
Olufemi Olatigbe, Sabba Hussain, Anna Bridgens, Shamim Umarji, Caroline Hing, Fergal Monsell, Yael Gelfer
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Abstract

Purpose: The British Orthopaedic Association Standards for Trauma-4 includes pediatric Gustilo-Anderson type I upper limb open fractures and recommends surgical debridement as the preferred method of treatment. The reported incidence of fracture-related infection is low in patients with this injury pattern and the evidence supporting debridement is therefore weak. The aim of this systematic review is to compare infection rates between non-operative management and operative debridement in children with Gustilo I upper limb fractures who did not require surgical fixation.

Methods: A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Eligibility criteria included patients <18 years with Gustilo-Anderson type I upper limb fractures managed with either antibiotics alone or with operative debridement. Patients in whom the fracture was stabilized were excluded, and the Risk Of Bias In Non-randomized Studies-of Interventions tool was used to evaluate bias.

Results: Eleven, predominantly retrospective studies were identified, involving 537 patients with fractures including 466 forearm, 70 wrist, and one humerus. A non-operative management strategy was used in 293 patients with one superficial infection (0.3%). Operative debridement was used in 244 patients with one superficial infection (0.4%).

Conclusion: The optimal management of Gustilo-Anderson type I pediatric upper limb fractures is unclear. Based on the current evidence base, surgical debridement does not appear to reduce the rate of infection. The decision to manage these injuries aggressively should therefore be individualized to consider patient age, mechanism, and clinical extent of injury.

Level of evidence: level II.

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小儿古斯蒂洛-安德森I型上肢开放性骨折的初期处理:抗生素就够了吗?
目的:英国骨科协会《创伤标准-4》包括小儿古斯蒂洛-安德森 I 型上肢开放性骨折,并建议首选手术清创治疗方法。据报道,在这种损伤模式的患者中,骨折相关感染的发生率较低,因此支持清创的证据不足。本系统性综述旨在比较不需要手术固定的古斯蒂洛Ⅰ型上肢骨折患儿在非手术治疗和手术清创治疗之间的感染率:方法:采用系统综述和元分析首选报告项目指南进行系统综述。资格标准包括患者:共确定了 11 项主要为回顾性的研究,涉及 537 名骨折患者,其中包括 466 名前臂骨折患者、70 名腕部骨折患者和 1 名肱骨骨折患者。293 名患者采用了非手术治疗策略,其中有一名患者发生了表皮感染(0.3%)。244例患者(0.4%)发生表皮感染,采用了手术清创疗法:结论:Gustilo-Anderson I型小儿上肢骨折的最佳治疗方法尚不明确。根据目前的证据基础,手术清创似乎并不能降低感染率。因此,在决定是否积极处理这些损伤时,应根据患者的年龄、受伤机制和临床程度进行个体化处理。
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来源期刊
Journal of Childrens Orthopaedics
Journal of Childrens Orthopaedics Medicine-Orthopedics and Sports Medicine
CiteScore
2.70
自引率
14.30%
发文量
61
审稿时长
23 weeks
期刊介绍: Aims & Scope The Journal of Children’s Orthopaedics is the official journal of the European Paediatric Orthopaedic Society (EPOS) and is published by The British Editorial Society of Bone & Joint Surgery. It provides a forum for the advancement of the knowledge and education in paediatric orthopaedics and traumatology across geographical borders. It advocates an increased worldwide involvement in preventing and treating musculoskeletal diseases in children and adolescents. The journal publishes high quality, peer-reviewed articles that focus on clinical practice, diagnosis and treatment of disorders unique to paediatric orthopaedics, as well as on basic and applied research. It aims to help physicians stay abreast of the latest and ever-changing developments in the field of paediatric orthopaedics and traumatology. The journal welcomes original contributions submitted exclusively for review to the journal. This continuously published online journal is fully open access and will publish one print issue each year to coincide with the EPOS Annual Congress, featuring the meeting’s abstracts.
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