Study of twenty-seven paediatric patients with open tibial fracture: the role of definitive skeletal stabilisation.

Background: The aim of this retrospective study was to review our practice of the management of open tibial fractures in children.

Methods: Twenty-seven children aged 3-15 years (mean 9.5) with open fractures of the tibia were treated with early aggressive wound debridement and lavage. Gustilo grading was used. The wounds were graded as follows: I (13 patients), II (6 patients), IIIa (3 patients), IIIb (5 patients). Open wounds were treated as appropriate, 30% of patients required a plastic surgical procedure.

Results: Five patients were treated by initial external fixation of the tibia; the remainder was treated by cast immobilisation. The mean period for fracture healing was 6 months (1.5-48 months). There were no cases of non-union or deep infection. The incidence of complications where external fixation was applied was significant: one malunion required osteotomy, there were 2 cases of delayed union and four cases of pin track infection. In the group treated in casts, the most significant complication was loss of reduction of the fracture (five cases), requiring conversion to external fixation in 2 and screw and wire fixation in another; the remaining cases of displaced fractures responded to re-manipulation and plaster application.

Conclusions: We conclude from our results hat majority of isolated open tibial fracture in children can be treated by wound debridement and plaster cast immobilisation. There is still a role for the use of external fixation especially where there is a grossly unstable fracture or extensive soft tissue injury requiring a flap procedure.