The Management of Pediatric Open Forearm Fractures

Antibiotics Within One Hour for Pediatric Open Lower Extremity Fractures May Not be Warranted as a Quality Metric

BACKGROUND

Open fractures have been associated with a higher risk of infection if antibiotics are not administered within 1 h of presentation in adult trauma patients. Time to antibiotic administration for open fractures is frequently used as a quality metric for trauma centers, but there have been no large studies evaluating this topic for pediatric patients.

METHODS

The 2019 Trauma Quality Improvement Program dataset was queried for patients ≤ 16 years old with isolated open femur or tibia fractures undergoing operative intervention after blunt trauma. Patients transferred from another hospital were excluded. Pediatric patients receiving early antibiotics (EA) within 1 h were compared to patients receiving delayed antibiotics (DA) greater than or equal to 1 h from arrival. Multivariate logistic regression was used to evaluate risk of surgical site infection (SSI).

RESULTS

There were 150 patients with open lower extremity fractures: 98 (64.9%) EA vs 52 (34.4%) DA. There was no difference in the rate of SSI between the 2 groups (EA: 1.0% vs DA: 1.9%, P = 0.65). There remained similar associated risk of infection after adjusting for lower extremity abbreviated injury scale >3, blood transfusion requirement, and vital signs on arrival (OR 0.62, 95% CI 0.04-10.24, P = 0.74).

CONCLUSIONS

Most pediatric trauma patients with open lower extremity fracture received antibiotics within 1 h of presentation. However, SSI was rare and the risk of SSI was not associated with antibiotic administration within 1 h. Therefore, timing of antibiotic administration for pediatric open lower extremity fractures should be re-evaluated as a quality metric.Level of Evidence: Level III.

Management of Open Pediatric Fractures: Proposal of a New Multidisciplinary Algorithm

BACKGROUND

An algorithm for managing open fractures in children is still being debated; the present study suggests an evidence-based way to manage these patients in the emergency department.

METHODS

The literature on "Open fractures in children" was carefully analyzed using keywords. The primary sources were The Cochrane Library, PubMed, and Researchgate.

CONCLUSION

We proposed an evidence-based algorithm for managing open fractures in children to standardize clinical practice and improve the care of these patients.

Evaluation of the Functional Outcome of Both Bone Forearm Fractures in the Pediatric Population With the Titanium Elastic Nailing System in a Tertiary Care Center

Background Forearm fractures are one of the most common injuries in the pediatric population. Diaphyseal fractures of the forearm, in particular, are among the most common injuries treated in the pediatric population. The incidence of both bone forearm fractures has increased in the past decade. Methodology This is a hospital-based retrospective study conducted from June 2020 to December 2022 at R. L. Jalappa Hospital and Research Centre in the orthopedics department after obtaining clearance from the institutional ethics committee. Once inclusion and exclusion criteria are met, participants with both bone forearm fractures were treated with the Titanium Elastic Nailing System (TENS). Data were entered and analyzed using IBM Corp. Released 2011, IBM SPSS Statistics for Windows, Version 20.0 (IBM Corp, Armonk, NY, USA). Results Thirty patients were included in the study, with a mean age of 8.80 years. The majority were boys constituting 67% and girls constituting 33%. A road traffic accident was the mechanism of injury in the majority of patients (40%). The distal one-third forearm was the most common site fractured (63%). The mean flexion (active) at the elbow improved from 110°at at four weeks to 142° at 24 weeks. A restriction of about 23° in elbow extension at four weeks normalized to 0° at 24 weeks. The range of palmar flexion improved from 44° at four weeks to 68° at 24 weeks. The range of wrist dorsiflexion improved significantly over time from 46° at four weeks to 86° at 24 weeks. Complications such as delayed union and skin irritation were noted in two participants (6%). Conclusions Both bone forearm fractures treated with TENS have shown good results in terms of bony union and functional outcomes with the least complications.

Pediatric Open Long-Bone Fracture and Subsequent Deep Infection Risk: The Importance of Early Hospital Care

The purpose of the current study was to identify risk factors for deep infection after an open long-bone fracture in pediatric patients. Systematic billing queries were utilized to identify pediatric patients who presented to a level I trauma center from 1998 to 2019 with open long-bone fractures. There were 303 open long-bone fractures, and 24 (7.9%) of these became infected. Fractures of the tibia/fibula (p = 0.022), higher revised Gustilo-Anderson type (p = 0.017), and a longer duration of time between the injury and hospital presentation (p = 0.008) were all associated with the presence of deep infection. Those who went on to have a deep infection also required more operative debridements (p = 0.022) and a total number of operative procedures (p = 0.026). The only factor that remained significant in multivariable regression was the duration between the injury and hospital presentation (OR 1.01 [95%CI 1.003-1.017]; p = 0.009), where the odds of deep infection increased by 1% for every minute of delayed presentation.