Abbas Memon, Muhammad Ali, Faheem Memon, Muhammad Ayoob Lagari, Kasiddiqui.
Management of open fractures of tibia in children.
J Pak Orthop Assoc Jan ;20(1):81-7.

Objective: To achieve union of open fractures of tibia and uncomplicated healing of soft tissue associated with open fractures in children. Design of Study: A prospective study. Place and Duration of Study: Department of Orthopaedics, Unit-I, LUMHS, Jamshoro/Hyderabad, from January 2002 to 2006. Patients and Methods: 50 open fractures of tibia in children were treated in the department of Orthopaedics, Unit-I, LUMHS, Jamshoro/Hyderabad. The most common cause was road traffic accident (56%) and maximum age group affected was 8-10 years (48%). Gustilo classification of severity was used for grading the injury and maximum fractures were GI (44%) type. Middle one-third of shaft was the most common site of involvement. Open fractures were managed with thorough debridement, use of prophylactic antibiotics, early stabilization and reconstruction of soft tissue envelops, 34 (68%) fractures were treated by manipulative reduction and application of above knee-plaster cast, 13 (26%) fractures stabilized with external fixator and 2 (4%) with K-wires. Early amputation was unavoidable in one patient with GIII-C injury. Results: Average healing time of soft tissues was 7 weeks, 8 children had split skin graft, 3 had local myocutaneous flaps and 2 needed cross leg flap. Average time for union was 8 weeks in GI, 9.5 weeks in GII, and 16 weeks in GIII. Three (6%) cases had pin tract infection, 4 (8%) had superficial wound infection and one (2%) had deep infection. Six (12%) children developed malunion and 3 (6%) developed delayed union. Conclusion: Prophylactic antibiotic and early wound debridement gives good results. External fixation is a method of choice in GIII B in tibial fractures in children.

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