TREATMENT OF TYPE-II AND TYPE-III OPEN TIBIA FRACTURES IN CHILDREN

Objectives: To determine whether severe open tibial fractures in child ren behave like similar fractures in adults. Design and Setting: A com bined retrospective and prospective review evaluated treatment protoco l for type II and type III open tibial fractures in children over a te n-year period from 1984 to 1993. Patients: Twenty-three fractures were studied in children aged 3.5 to 14.5 (18 boys and 5 girls). There wer e six type II, eight type IIIA, and nine type IIIB fractures. Type I f ractures were not included. Seven fractures were comminuted with signi ficant butterfly fragments or segmental patterns. Intervention: Treatm ent consisted of adequate debridement of soft tissues, closure of dead space, and stabilization with external fixation. Bone debridement onl y included contaminated devitalized bone or devitalized bone without s oft tissue coverage. Bone that could be covered despite periosteal str ipping was preserved. Main Outcome Measurements: Clinical and roentgen ographic examinations were used to determine time to union. Results: A ll fractures in this series healed between eight and twenty-six weeks. Wound coverage included two flaps, three skin grafts, and two delayed primary closures. No bone grafts were required. There were no deep in fections, growth arrests, or malunions. Follow-up has ranged from six months to four years. Conclusions: Open tibia fractures in children di ffer from similar fractures in adults in the following ways: soft tiss ues have excellent healing capacity, devitalized bone that is not cont aminated or exposed can be saved and will become incorporated, and ext ernal fixation can be maintained until the fracture has healed. Perios teum in young children can form bone even in the face of bone loss.