SEVERE (TYPE-III) OPEN FRACTURES OF THE TIBIA IN CHILDREN

Twenty children with acute type III open fractures of the tibial metap hyses or diaphysis were retrospectively studied. The average age was 9 years, 1 month (range, 2 years, 11 months to 16 years, 2 months). The re were seven type IIIA fractures, 10 type IIIB fractures, and 3 type IIIC fractures. All fractures were irrigated and debrided, and prophyl actic antibiotics were given for a minimum of 48 h. Fifteen fractures were initially treated with external fixation, three with casts, one w ith internal fixation, and one with a combination of external fixation and limited internal fixation. Free muscle flaps were used for soft-t issue coverage in six patients, and a local muscle flap in one patient . The average time to fracture healing was 29 weeks, and the median ti me to fracture healing was 20 weeks (range, 8-104). Four patients had delayed union, and two additional patients had nonunion. Both patients with nonunion were successfully treated with autologous bone grafting . The time to fracture union was related to the severity of soft-tissu e injury, fracture configuration, segmental bone loss, and infection. Osteomyelitis developed in three patients. All were successfully treat ed. Two patients treated with external fixation had leg-length discrep ancies of >1 cm, with the injured extremity longer in both cases. Ther e were no late amputations. Children with severe open fractures of the tibia have a good prognosis for limb salvage with aggressive wound ca re and fracture management.