Soft tissue management of children's open tibial fractures--a review of seventy children over twenty years.
Ann R Coll Surg Engl
; 92(4): 320-5, 2010 May.
Article
in En
| MEDLINE
| ID: mdl-20501017
ABSTRACT
INTRODUCTION:
The management of open tibial fractures in children represents a unique reconstructive challenge. The aim of the study was to evaluate the management of paediatric open tibial fractures with particular regard to soft tissue management. PATIENTS ANDMETHODS:
A retrospective case-note analysis was performed for all children presenting with an open tibial fracture at a single institution over a 20-year period for 1985 to 2005.RESULTS:
Seventy children were reviewed of whom 41 were males and 29 females. Overall, 91% (n = 64) of children suffered their injury as a result of a vehicle-related injury. The severity of the fracture with respect to the Gustilo classification was Grade I, 42% (n = 29); Grade II, 24% (n = 17); Grade III, 34% (n = 24; 7 Grade 3a, 16 Grade 3b, 1 Grade 3c). The majority of children were treated with external fixation and conservative measures, with a mean hospital in-patient stay of 13.3 days. Soft tissue cover was provided by plastic surgeons in 31% of all cases. Four cases of superficial wound infection occurred (6%), one case of osteomyelitis and one case of flap failure. The limb salvage was greater than 98%.CONCLUSIONS:
In this series, complications were associated with delayed involvement of plastic surgeons. Retrospective analysis has shown a decreased incidence of open tibial fractures which is reported in similar studies. Gustilo grade was found to correlate with length of hospital admission and plastic surgery intervention. We advocate, when feasible, the use of local fasciocutaneous flaps (such as distally based fasciocutaneous and adipofascial flaps), which showed a low complication rate in children.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Tibial Fractures
/
Soft Tissue Injuries
/
Plastic Surgery Procedures
/
Fractures, Open
Type of study:
Etiology_studies
/
Evaluation_studies
/
Observational_studies
/
Risk_factors_studies
Limits:
Adolescent
/
Child
/
Child, preschool
/
Female
/
Humans
/
Male
Language:
En
Journal:
Ann R Coll Surg Engl
Year:
2010
Document type:
Article
Affiliation country:
Reino Unido