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Boukhentiche A, Benmayouf N, Derdous C, Boudjouraf N, Khernane N. Management of Open Supracondylar Humeral Fracture in Children: A Case Report and Literature Review. Cureus 2023; 15:e48119. [PMID: 38046701 PMCID: PMC10691840 DOI: 10.7759/cureus.48119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2023] [Indexed: 12/05/2023] Open
Abstract
Open supracondylar humeral fractures (SHFs) are rare, and there have been few papers specifically addressing their management. In this report, we describe the management and 27-month outcomes of an open SHF. A healthy eight-year-old boy presented with open SHF of the right elbow and underwent percutaneous lateral fixation using two Kirschner wires (K-wire) after irrigation and debridement (I&D) through an anterior approach. Excellent outcomes were obtained without any complications over a 27-month follow-up period. The management of open SHFs in children is yet to be standardized; nevertheless, we believe that I&D is a crucial step, that well-done lateral entry K-wires could provide the required stability, that the anterior approach is logical, safe, and effective, and that the high healing potential of children is our ally in such injuries.
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Affiliation(s)
- Abdallah Boukhentiche
- Orthopedic Surgery, Benflis Touhami University Hospital, Batna, DZA
- Orthopedic Surgery, Batna Specialist Emergency Hospital, Batna, DZA
| | - Nazim Benmayouf
- Orthopedic Surgery, Benflis Touhami University Hospital, Batna, DZA
| | - Chaouki Derdous
- Orthopedic Surgery, Benflis Touhami University Hospital, Batna, DZA
| | - Nouar Boudjouraf
- Orthopedic Surgery, Benflis Touhami University Hospital, Batna, DZA
- Orthopedic Surgery, Batna Specialist Emergency Hospital, Batna, DZA
| | - Nacer Khernane
- Orthopedic Surgery, Benflis Touhami University Hospital, Batna, DZA
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2
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Abstract
PURPOSE Supracondylar humerus (SCH) fractures are the most common elbow fracture in children; however, they rarely occur as open injuries. Open fractures are associated with higher rates of infection, neurovascular injury, compartment syndrome, and nonunion. The purpose of this study was to evaluate the treatment and outcomes of open SCH fractures in children. METHODS Between 2008 and 2015, four children (1%) had open injuries among 420 treated for SCH fractures at a single center. The mean patient age was six years (range, four to eight years). Two patients had Gustilo-Anderson grade 1 open fractures and two had grade 2 fractures. Tetanus immunization was up-to-date in all. First dose of intravenous antibiotics was given on average 3hr 7min after onset of injury (range, 1hr 38min to 8hr 15min). Time from injury to irrigation and debridement (I&D) and closed reduction and percutaneous pinning (CRPP) was on average 8hr 16min (range, 4hr 19min to 13hr 15min). All patients received 24-hour intravenous antibiotics. Pins were removed at four weeks and bony union occurred by six weeks. RESULTS After an average follow-up period of 12 months (range, 6 to 22 months), there were no infections, neurovascular deficits, compartment syndromes, cubitus varus deformities, or range of motion losses. All outcomes were excellent according to the Flynn criteria. Due to the unstable nature of open SCH fractures, a medial pin was used in all four cases. No loss of reduction or ulnar nerve injury occurred. CONCLUSION Open injuries occur in approximately 1% of all SCH fractures in children. The authors recommend urgent intravenous antibiotics, I&D, and CRPP involving a medial pin to treat open SCH fractures. Excellent outcomes based on the Flynn criteria were obtained in four cases.
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Affiliation(s)
- Tommy Pan
- Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Hershey, USA
| | - Matthew R Widner
- Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Hershey, USA
| | - Michael M Chau
- Department of Orthopaedic Surgery, University of Minnesota Twin Cities, Minneapolis, USA
| | - William L Hennrikus
- Department of Orthopaedics and Rehabilitation, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
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3
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Rölfing JD, Bue M, Kiil B, Petruskevicius J. Resect or Retain Bone Fragments in Children and Teenagers with Severe Open Fractures?: A Case Report. JBJS Case Connect 2020; 10:e20.00390. [PMID: 33449544 DOI: 10.2106/jbjs.cc.20.00390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 14-year-old pedestrian was hit by a car and encountered similar bilateral Gustilo IIIB open tibial fractures. The right tibial fracture involved a large borderline vital butterfly fragment without periosteal contact, which was retained and proceeded to sufficient healing within 12 weeks. The left tibial fracture was treated according to the principles for the treatment of severe open fractures in adults, involving resection of devitalized fragments and bone transport, and healed within 15 months. CONCLUSIONS Teenagers do possess larger bone healing potential than adults. Therefore, a rapid bone union can be achieved even with apparently devitalized bone fragments if sufficient soft-tissue closure and stable fracture fixation is established early in the treatment of open limb fractures.
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Affiliation(s)
- Jan Duedal Rölfing
- Department of Orthopedics, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Mats Bue
- Department of Orthopedics, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Birgitte Kiil
- Department of Plastic and Breast Surgery, Aarhus University Hospital, Aarhus, Denmark
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Elia G, Blood T, Got C. The Management of Pediatric Open Forearm Fractures. J Hand Surg Am 2020; 45:523-527. [PMID: 32265052 DOI: 10.1016/j.jhsa.2020.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 01/21/2020] [Accepted: 02/15/2020] [Indexed: 02/02/2023]
Abstract
Open pediatric forearm fractures are common injuries that present to emergency departments across the United States. A total of 32% to 80% of all open pediatric fractures involve the forearm. Standard treatment for these injuries includes prompt intravenous antibiotic administration, tetanus prophylaxis, and usually bedside irrigation as a temporizing measure. Gustilo and Anderson type 2 and 3 open pediatric forearm fractures are generally managed with formal irrigation and debridement and fracture stabilization in the operating room. Management of Gustilo and Anderson type 1 open pediatric forearm fractures is not standardized, and level I evidence is currently lacking. Based on the existing data available, early antibiotic administration, bedside irrigation, and fracture stabilization in the emergency department may be a safe and effective initial treatment for these injuries, conferring a low risk for subsequent infection.
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Affiliation(s)
- Gregory Elia
- Department of Orthopaedic Surgery, Providence, RI; Warren Alpert Medical School of Brown University, Providence, RI.
| | - Travis Blood
- Department of Orthopaedic Surgery, Providence, RI; Warren Alpert Medical School of Brown University, Providence, RI
| | - Christopher Got
- Department of Orthopaedic Surgery, Providence, RI; Warren Alpert Medical School of Brown University, Providence, RI
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Agarwal S, Sarkar S, Agarwal M. “A journey from doom to bloom” – A rare case of low-energy pediatric open supracondylar fracture of humerus with brachial artery laceration managed with “Orthoplastic Approach”. JOURNAL OF ORTHOPAEDICS AND SPINE 2020. [DOI: 10.4103/joasp.joasp_16_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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6
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Tevanov I, Enescu DM, Carp M, Dusca A, Ladaru A, Ulici A. Negative pressure wound therapy in reconstructing extensive leg and foot soft tissue loss in a child: a case study. J Wound Care 2019; 27:S14-S19. [PMID: 29883293 DOI: 10.12968/jowc.2018.27.sup6.s14] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Open fractures of the leg with large loss of tissue require extensive reconstructive methods that can injure the donor area. The use of negative pressure wound therapy (NPWT) may minimise the impact of these reconstructive methods because of its capacity to create granulation tissue that will form a wound bed for the skin graft, thus reducing the volume of soft tissue defect and saving the donor region. This case study describes the effectiveness of NPWT in the treatment and reconstruction of an open fracture of the leg, with massive loss of soft tissue, associated with elastic intramedullary nailing in a 10-year-old female patient, who was a victim of a car accident. Clinical examination revealed a Gustilo-Anderson IIIB open fracture of the left leg, with the avulsion of the fifth toe, disarticulation of the fifth metatarsal bone, extensively damaged skin and subcutaneous tissue in the medium and distal third of the left leg and left foot. The bone was exposed in the distal part of the leg, external malleolus and left calcaneus. Profuse lavage, reduction of the tibial fracture and elastic intramedullary nailing, amputation of the fifth left toe, necrectomy and debridement of devitalised tissue were performed. NPWT was started, with the dressing changed every five days. After 55 days of using NPWT, granulation tissue covered the soft tissue defect and created a wound bed for the skin graft. NPWT helped the management of this open wound, achieving a wound bed for the skin graft, avoiding the use of complex reconstructive methods.
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Affiliation(s)
- Iulia Tevanov
- Pediatric Orthopedic Surgeon, Department of Pediatric Orthopedic Surgery, Emergency Hospital for Children 'Grigore Alexandrescu', Bucharest, Romania
| | - Dan Mircea Enescu
- Professor, Department of Plastic and Reconstructive Surgery, Emergency Hospital for Children 'Grigore Alexandrescu', Bucharest, Romania, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Madalina Carp
- Pediatric Orthopedic Surgeon, Department of Pediatric Orthopedic Surgery, Emergency Hospital for Children 'Grigore Alexandrescu', Bucharest, Romania
| | - Andrei Dusca
- Pediatric Orthopedic Surgeon, Department of Pediatric Orthopedic Surgery, Emergency Hospital for Children 'Grigore Alexandrescu', Bucharest, Romania
| | - Alin Ladaru
- Student, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Alexandru Ulici
- President of the Romanian Pediatric Orthopedic Society, Chief of Surgery, Associate Professor, Department of Pediatric Orthopedic Surgery, Emergency Hospital for Children 'Grigore Alexandrescu', Bucharest, Romania, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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Abstract
We evaluated the novel application of supracutaneous locked plates in pediatric open tibia fractures. Pediatric open tibia fractures stabilized with a locked supracutaneous plate from January 2011 to December 2014 were reviewed. Twenty-eight children, mean age 8.9 years, with 29 open tibia fractures were included. Nine of these children who had metaphyseal or metadiaphyseal fractures did not require joint spanning. The mean follow-up duration was 13.5 months. The mean time to uneventful union was 11.46 weeks, with no unacceptable malunion. Supracutaneous locked plates showed early union and no refractures. They could favorably replace tubular external fixators in stabilizing pediatric open tibia fractures.
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Abstract
Open fractures in children differ from adults owing to their better healing potential. Management strategies for open fracture in children are changing with improvement in our understanding of soft-tissue reconstruction and fracture fixation. A literature review was performed for articles covering management of open fractures in children. The cornerstones of management include prevention of infection, debridement, and skeletal stabilization with soft-tissue coverage. The injury should be categorized according to the established trauma classification systems. Timely administration of appropriate antibiotics is important for preventing infections. Soft-tissue management includes copious irrigation and debridement of the wound. Fractures can be stabilized by a variety of nonoperative and operative means, taking into consideration the special needs of the growing skeleton and the role of a thick and active periosteum in the healing of fractures. The soft-tissue coverage required depends on the grade of injury.
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Affiliation(s)
- Akshat Sharma
- Department of Paediatric Orthopaedics, KUMC GURO Hospital, Seoul, Korea,Address for correspondence: Dr. Akshat Sharma, 15, Nav Vikas Apartments, Sector – 15, Rohini, New Delhi - 110 089, India. E-mail:
| | - Vikas Gupta
- Central Institute of Orthopaedics, Safdarjung Hospital, New Delhi, India
| | - Kumar Shashikant
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
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9
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Demirel M, Tunali O, Turkmen I, Saglam Y. As a Definitive Choice of Treatment, Joint and Defect Spanning Multiplanar Tubular External Fixation in the Management of Pediatric Open Defective Supracondylar Humerus Fracture: A Case Report. J Orthop Case Rep 2017; 7:84-88. [PMID: 29242803 PMCID: PMC5728008 DOI: 10.13107/jocr.2250-0685.908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Although supracondylar fractures of the humerus are common in children, open fractures of are extremely rare injuries. Gustilo- Anderson Type-III fractures in the upper extremity are primarily associated with considerable bone loss resulting from high energy trauma. In this study, a case of open pediatric supracondylar humerus fracture treated by a joint and defect spanning multiplanar tubular external fixation is presented. Case Report: A boy aged 3 years suffered from a Gustilo-Anderson Type-IIIA supracondylar humerus fractures. There was no neurovascular compromise. Intravenous antibiotic regimen was introduced. A joint and defect spanning multiplanar tubular external fixation was employed within 4 h of the accident. After the operation, the patient was closely followed in the inpatients unit. The external fixator was removed in the 6th week of follow-up, and range of motion exercises was started. With the exception of limited flexion of the elbow in 12th month of follow-up, supination and pronation were full. At the 48th month follow-up, 120° of elbow flexion, full extension, and full forearm rotation were observed. Physical examination showed 15° change in carrying angle to cubitus varus; radiologic examination showed a slight varus angulation of the distal humerus, a decreased Baumann’s angle. The Mayo elbow performance score was 100 points. Conclusion: When taking into account the high remodeling capacity, healing potential, and greater resistance to joint stiffness in fractures of children, joint and external fixators appear as a viable definitive treatment in such cases.
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Affiliation(s)
- Mehmet Demirel
- Department of Orthopedic and Traumatology, Istanbul University, Istanbul Faculty of Medicine, Millet cad, Vatan bulvarı, Fatih, Çapa, Istanbul - 34100, Turkey
| | - Onur Tunali
- Department of Orthopedic and Traumatology, Maslak Acibadem Hospital, Atakoy 4. Kisim, TO 211, Daire: 10, Bakirkoy, Istanbul, Turkey
| | - Ismail Turkmen
- Department of Orthopedic and Traumatology, Umraniye Training and Research Hospital, Elmalıkent, Adem Yavuz Cd. No:1, 34766 Ümraniye, Istanbul, Turkey
| | - Yavuz Saglam
- Department of Orthopedic and Traumatology, Biruni University Hospital, Beşyol, Eski Londra Asfaltı No:10, 34295 Küçükçekmece, Istanbul, Turkey
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10
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Zhang H, Fanelli M, Adams C, Graham J, Seeley M. The emerging trend of non-operative treatment in paediatric type I open forearm fractures. J Child Orthop 2017; 11:306-309. [PMID: 28904637 PMCID: PMC5584500 DOI: 10.1302/1863-2548.11.170027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Open fractures are considered an orthopaedic emergency and are generally an indication for operative debridement. Recent studies have questioned this approach for the management of Gustilo-Anderson Type I open fractures in the paediatric population. This meta-analysis studies the non-operative management of Type I open paediatric forearm fractures. METHODS An Ovid MEDLINE and PubMed database literature search was performed for studies that involved a quantified number of Gustilo-Anderson Type I open forearm fractures in the paediatric population, which were treated without operative intervention. A fixed-effect meta-analysis, weighting each study based on the number of patients, and a pooled estimate of infection risk (with 95% confidence interval (CI)) was performed. RESULTS The search results yielded five studies that were eligible for inclusion. No included patients had operative debridement and all were treated with antibiotics. The number of patients in each study ranged from 3 to 45, with a total of 127 paediatric patients in the meta-analysis. The infection rate was 0% for all patients included. The meta-analysis estimated a pooled infection risk of 0% (95% CI 0 to 2.9). CONCLUSIONS The five included studies had a total of 127 patients with no cases of infection after non-operative management of Type I open paediatric forearm fractures. The infection rate of Type I fractures among operatively managed patients is 1.9%. The trend in literature towards non-operative treatment of paediatric Type I open fractures holds true in this meta-analysis.
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Affiliation(s)
- H. Zhang
- Geisinger Health System, Department of Orthopaedics, Danville, PA 17822, USA,Correspondence should be sent to: Hui Zhang, Geisinger Health System, Department of Orthopaedics, Danville, PA 17822, USA. E-mail:
| | - M. Fanelli
- Geisinger Health System, Department of Orthopaedics, Danville, PA 17822, USA
| | - C. Adams
- University of Vermont College of Medicine, Burlington, VT 05405, USA
| | - J. Graham
- Geisinger Health System, Department of Orthopaedics, Danville, PA 17822, USA
| | - M. Seeley
- Geisinger Health System, Department of Orthopaedics, Danville, PA 17822, USA
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11
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Abstract
Open fractures in children are rare and are typically associated with better prognoses compared with their adult equivalents. Regardless, open fractures pose a challenge because of the risk of healing complications and infection, leading to significant morbidity even in the pediatric population. Therefore, the management of pediatric open fractures requires special consideration. This article comprehensively reviews the initial evaluation, classification, treatment, outcomes, and controversies of open fractures in children.
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Affiliation(s)
- Arianna Trionfo
- Department of Orthopaedic Surgery, Temple University School of Medicine, 3401 North Broad Street, Philadelphia, PA 19140, USA.
| | - Priscilla K Cavanaugh
- Department of Orthopaedic Surgery, St. Christopher's Hospital for Children, Drexel University College of Medicine, 160 East Erie Avenue, Philadelphia, PA 19134, USA
| | - Martin J Herman
- Department of Orthopaedic Surgery, St. Christopher's Hospital for Children, Drexel University College of Medicine, 160 East Erie Avenue, Philadelphia, PA 19134, USA
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12
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Type I Open Fractures Benefit From Immediate Antibiotic Administration But Not Necessarily Immediate Surgery. J Pediatr Orthop 2016; 36 Suppl 1:S6-S10. [PMID: 27100039 DOI: 10.1097/bpo.0000000000000766] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Pediatric open fractures are rare, occurring in approximately 2% to 9% of all pediatric fractures. Type I open fractures represent the most common type of open fractures seen in pediatrics and are commonly caused by low-energy mechanisms. The management of these injuries has been primarily dictated by the adult literature. Immediate antibiotic administration, specifically a first generation cephalosporin, has been shown to reduce infection rates. The duration of antibiotic treatment is less clear, but longer courses of antibiotics have not been significantly better than a shorter course. Retrospective case series have shown no difference in infection rates with nonoperative management of type I open fractures. However, concern regarding serious and even life-threatening infection continues to limit the universal adoption of nonoperative treatment protocols. A prospective randomized control trial is underway and will hopefully elucidate which open fractures can be safely managed with prompt antibiotic administration and nonoperative care.
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13
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Halawi MJ, Morwood MP. Acute Management of Open Fractures: An Evidence-Based Review. Orthopedics 2015; 38:e1025-33. [PMID: 26558667 DOI: 10.3928/01477447-20151020-12] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 04/08/2015] [Indexed: 02/03/2023]
Abstract
Open fractures are complex injuries associated with high morbidity and mortality. Despite advances made in fracture care and infection prevention, open fractures remain a therapeutic challenge with varying levels of evidence to support some of the most commonly used practices. Additionally, a significant number of studies on this topic have focused on open tibial fractures. A systematic approach to evaluation and management should begin as soon as immediate life-threatening conditions have been stabilized. The Gustilo classification is arguably the most widely used method for characterizing open fractures. A first-generation cephalosporin should be administered as soon as possible. The optimal duration of antibiotics has not been well defined, but they should be continued for 24 hours. There is inconclusive evidence to support either extending the duration or broadening the antibiotic prophylaxis for type Gustilo type III wounds. Urgent surgical irrigation and debridement remains the mainstay of infection eradication, although questions persist regarding the optimal irrigation solution, volume, and delivery pressure. Wound sampling has a poor predictive value in determining subsequent infections. Early wound closure is recommended to minimize the risk of infection and cannot be substituted by negative-pressure wound therapy. Antibiotic-impregnated devices can be important adjuncts to systemic antibiotics in highly contaminated or comminuted injuries. Multiple fixation techniques are available, each having advantages and disadvantages. It is extremely important to maintain a high index of suspicion for compartment syndrome, especially in the setting of high-energy trauma.
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Bertani A, Mathieu L, Dahan JL, Launay F, Rongiéras F, Rigal S. War-related extremity injuries in children: 89 cases managed in a combat support hospital in Afghanistan. Orthop Traumatol Surg Res 2015; 101:365-8. [PMID: 25825017 DOI: 10.1016/j.otsr.2015.02.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 01/12/2015] [Accepted: 02/12/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Meeting paediatric needs is among the priorities of western healthcare providers working in Afghanistan. HYPOTHESIS Insufficient information is available on paediatric wartime injuries to the extremities. Our objective here was to describe these injuries and their management on the field. MATERIALS AND METHODS We retrospectively reviewed consecutive cases of injuries to the extremities in children (< 16 years of age) due to weapons and managed at the Kabul International Airport (KaIA) Combat Support Hospital between June 2009 and April 2013. We identified 89 patients with a mean age of 10.2 ± 3.5 years and a total of 137 elemental lesions. RESULTS Explosive devices accounted for most injuries (78.6%) and carried a significantly higher risk of multiple lesions. There were 54 bone lesions (traumatic amputations and fractures) and 83 soft-tissue lesions. The amputation rate was 18%. Presence of bone lesions was associated with a higher risk of injury to blood vessels and nerves. Of the 89 patients, four (4.5%) died and eight (9%) were transferred elsewhere. Of the 77 remaining patients, at last follow-up (median, one month; range, 0.1-16 months), 73 (95%) had achieved a full recovery (healed wound and/or fracture) or were recovering with no expectation that further surgery would be needed. DISCUSSION Despite the absence of paediatric surgeons, the combat support hospital provided appropriate care at the limb salvage and reconstruction phases. The highly specialised treatments needed to manage sequelae were very rarely provided. These treatments probably deserve to be developed in combat support hospitals.
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Affiliation(s)
- A Bertani
- Service de chirurgie orthopédique, HIA Desgenettes, Lyon, France.
| | - L Mathieu
- Service de chirurgie orthopédique, HIA Percy, Clamart, France
| | - J-L Dahan
- Service de réanimation, HIA Percy, Clamart, France
| | - F Launay
- Service d'orthopédie infantile, CHU Timone, Marseille, France
| | - F Rongiéras
- Service de chirurgie orthopédique, Military Teaching Hospital Desgenettes, Lyon, France
| | - S Rigal
- Chaire de chirurgie de guerre, French Military Health Service Academy, Paris, France
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15
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Iobst CA, Spurdle C, Baitner AC, King WF, Tidwell M, Swirsky S. A protocol for the management of pediatric type I open fractures. J Child Orthop 2014; 8:71-6. [PMID: 24488846 PMCID: PMC3935019 DOI: 10.1007/s11832-014-0554-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 01/07/2014] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND The management of pediatric type I open fractures remains controversial. There has been no consistent protocol established in the literature for the non-operative management of these injuries. METHODS A protocol was developed at our institution for the non-operative management of pediatric type I open forearm fractures. Each patient was given a dose of intravenous antibiotics at the time of the initial evaluation in the emergency department. The wound was then irrigated and a closed reduction performed in the emergency department. The patient was admitted for three doses of intravenous antibiotics (over approximately a 24-h period) and then discharged home without oral antibiotics. RESULTS In total, 45 consecutive patients were managed with this protocol at our hospital between 2004 and 2008. The average age was 10 (range 4-17) years. The average number of doses of intravenous antibiotics was 4.06 per patient. Thirty patients (67 %) received cefazolin (Ancef®) as the treating medication and 15 patients received clindamycin (33 %). There were no infections in any of the 45 patients. CONCLUSION In this study we outline a consistent management protocol for type I open pediatric forearm fractures that has not previously been documented in the literature. Our results corroborate the those reported in the literature that pediatric type I open fractures may be managed safely in a non-operative manner. There were no infections in our prospective series of 45 consecutive type I open pediatric forearm fractures using our protocol. Using a protocol of only four doses of intravenous antibiotics (one in the emergency department and three additional doses during a 24-h hospital admission) is a safe and efficient method for managing routine pediatric type I open fractures non-operatively.
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16
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Reimplantation of an extruded osteoarticular segment of the distal tibia in a 14-year-old girl. Case report and review of the literature. J Orthop Trauma 2012; 26:e24-8. [PMID: 22048178 DOI: 10.1097/bot.0b013e31821a06b0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This case report describes the reimplantation of a 15-cm osteoarticular segment of the distal tibia in a 14-year-old girl who was hit by a truck. The bone fragment was debrided and reimplanted on the day of injury. A free flap was performed within 1 week. Bony union was achieved without complication. At 5-year follow-up, the patient is able to ambulate for several hours at a time without an assistive device, although arthritis of the ankle joint is present. She scores 43.8 on the physical component of the 36-Item Short Form Health Survey and 49.0 on the mental component. The patient states that she is very pleased with her outcome. This seems to be the first description of an osteoarticular segment reimplantation of a long bone in the orthopaedic literature.
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Abstract
Polytrauma is a rare diagnosis in childhood. Even after high-energy accidents isolated injuries of the skull and brain or extremities are more common. Injury is still the most frequent cause of death in childhood in industrialized countries. The lethality of polytraumatized children is about 19%. Injuries of the extremities do not play such an important role for the survival of polytraumatized children but for the definitive outcome. The diagnostic algorithm for polytraumatized children is related to adults and includes spiral computed tomography in the emergency room. Plain radiographs are still the gold standard for the diagnostic workup of fractures. Generally therapeutic approaches in the treatment of fractures in children are often conservative. Because of the special situation in polytrauma with ICU care and the need for venous catheters, fast mobilization and positioning in bed, indications for operative treatment and definitive stabilization of fractures are required for polytraumatized children.
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Affiliation(s)
- P C Strohm
- Department Orthopädie und Traumatologie, Kindertraumatologie, Klinikum der Albert-Ludwigs-Universität Freiburg, Hugstetter Straße 55, 79106, Freiburg.
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Glass GE, Pearse M, Nanchahal J. The ortho-plastic management of Gustilo grade IIIB fractures of the tibia in children: a systematic review of the literature. Injury 2009; 40:876-9. [PMID: 19419715 DOI: 10.1016/j.injury.2008.12.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2008] [Revised: 12/10/2008] [Accepted: 12/12/2008] [Indexed: 02/02/2023]
Abstract
BACKGROUND The challenges of managing Gustilo IIIB tibial fractures in children are unique. A multi-disciplinary, evidence based approach is needed. We aimed to evaluate the evidence for the ortho-plastic management of Gustilo grade IIIB open tibial shaft fractures in children based on a review of all published data in order to rationalise the orthopaedic and plastic surgical approach to these complex injuries. METHOD A systematic review of the literature was performed. Gustilo grade IIIB tibial shaft fractures in pre-adolescent and adolescent children were identified and evaluated with regard to both the skeletal and soft tissue management, and the outcome. RESULTS Of 54 children with grade IIIB tibial fractures, a mean union time of 31 weeks included 33 weeks for 42 adolescents and 23 weeks for 12 pre-adolescents. Faster union time in pre-adolescents tended towards significance. Delayed union occurred in 22%, nonunion in 13%, mostly in adolescents. Two of 45 covered by vascularised flaps and 3 of 9 treated without flaps developed deep infection (p=0.028). There was no correlation between method of skeletal fixation and union time. CONCLUSION Gustilo IIIB tibial shaft fractures in pre-adolescents tended towards faster healing with fewer complications, irrespective of the method of skeletal fixation. In adolescents, healing times were similar to adults. Soft tissue closure without flaps was associated with deep infection in one-third of patients, requiring debridement and flap cover. Adequate debridement and flap cover is suggested in all cases, irrespective of age.
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Affiliation(s)
- Graeme E Glass
- Kennedy Institute of Rheumatology, Imperial College, ARC Building, 1 Aspenlea Road, Hammersmith, London, UK.
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Compartment syndrome of the thigh in an infant: a case report. CURRENT ORTHOPAEDIC PRACTICE 2008. [DOI: 10.1097/bco.0b013e3283031fe0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Compartment syndrome of the thigh in children is rare. We report a case of compartment syndrome of the thigh in an infant with a femur fracture resulting from suspected nonaccidental trauma. The delayed presentation of this injury may have been contributory to the development of compartment syndrome. The subtle physical findings in this case underscore the need for a high index of suspicion in making the diagnosis of compartment syndrome. The complete recovery of muscle function, even in the presence of significant tissue damage, is noteworthy and suggests that infants have a greater physiologic ability to recover in comparison with adults.
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Affiliation(s)
- Paul D Choi
- Department of Orthopaedic Surgery, University of Southern California, Keck School of Medicine, Children's Hospital Los Angeles, Los Angeles, California 90027, USA
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Affiliation(s)
- Kyu Hyun Yang
- Department of Orthopaedic Medicine, Yonsei University College of Medicine, Korea. ,
| | - Jin Park
- Department of Orthopaedic Medicine, Yonsei University College of Medicine, Korea. ,
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