OPEN FRACTURES OF THE TIBIA IN CHILDREN

The results of the treatment of open tibial fractures in 58 children a ged between 3 and 15 years are reviewed. There were 25 Gustilo Type I, 22 Type II and 10 Type III fractures. At operation 37 wounds were clo sed primarily and 21 wounds were left open. Of these 21, 13 healed by secondary intention and eight required split skin grafting or soft-tis sue flap coverage. Stable fractures were immobilized in an above-knee plaster in 48 cases (83 per cent) and six fractures treated with exter nal fixation (10 per cent). Two patients (3.5 per cent) had cast immob ilization of the tibial fracture and traction for an ipsilateral femor al fracture. Two patients (3.5 per cent) with Gustilo Type IIIc injuri es required an amputation, one 'de novo' as the limb was not salvageab le and one 4 days after failed vascular reconstruction. All fractures healed primarily without bone grafting, although there were three case s of delayed union and seven cases of malunion. Six children had super ficial wound infections but there were no cases of deep infection or o steomyelitis. There was one case of compartment syndrome.