Skip to main content
SpringerLink
Log in

Open Tibia Fractures in Children and Adolescents

  • Chapter
  • First Online:
Book cover Pediatric Orthopedic Surgical Emergencies

  • 1537 Accesses

Abstract

Open tibia fractures in children comprise only 2–3% of all fractures yet they account for one-third of open fractures that occur in this age group. Basic ­management principles are similar to those used to care for adults with open tibia fractures. Careful assessment of the child to rule out associated injuries, determination of soft tissue and neurovascular status of the fractured limb, administration of antibiotics in the Emergency room, and thorough irrigation and debridement in the operating room are keys to achieving good outcomes. While cast immobilization is an option for some open fractures, fixation is utilized for many open fractures. Flexible intramedullary nails, external fixation, percutaneous wire fixation, and plate-screw constructs are all effective in stabilizing these fractures and are selected based on age and the size of the child and the specifics of the injury.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Kreder HJ, Armstrong P. A review of open tibia fractures in children. J Pediatr Orthop. 1995;15:482–8.

    Article  PubMed  CAS  Google Scholar 

  2. Robertson P, Karol LA, Rab GT. Open fractures of the tibia and femur in children. J Pediatr Orthop. 1996;16:621–6.

    Article  PubMed  CAS  Google Scholar 

  3. Skaggs DL, Friend L, Alman B, Chambers HG, Schmitz M, Leake B, Kay RM, Flynn JM. The effect of surgical delay on acute infection following 554 open fractures in children. JBJS. 2005;87:8–12.

    Article  Google Scholar 

  4. Zalavras CG, Marcus RE, Levin LS, Patzakis MJ. Management of open fractures and subsequent complications. JBJS. 2007;89:884–95.

    Article  Google Scholar 

  5. Liow RYL, Montogomery RJ. Treatment of established and anticipated nonunion of the tibia in childhood. J Pediat Orthop. 2002;22:754–60.

    Article  Google Scholar 

  6. Hope PG, Cole WG. Open fractures of the tibia in children. J Bone Joint Surg Br. 1992;74-B:546–53.

    Google Scholar 

  7. Cramer KA, Limbird TJ, Green NE. Open fractures of the diaphysis of the lower extremity in children. Treatment, results, and complications. J Bone Joint Surg Am. 1992;74:218–32.

    PubMed  CAS  Google Scholar 

  8. Buckley SL, Smith G, Sponseller PD, et al. Open fractures of the tibia in children. J Bone Joint Surg Am. 1990;72:1462–9.

    PubMed  CAS  Google Scholar 

  9. Irwin A, Gibson P, Ashcroft P. Open fractures of the tibia in children. Injury. 1995;26:21–4.

    Article  PubMed  CAS  Google Scholar 

  10. Jones BG, Duncan RD. Open tibial fractures in children under 13 years of age—10 years experience. Injury. 2003;34:776–80.

    Article  PubMed  CAS  Google Scholar 

  11. Cullen MC, Roy DR, Crawford AH, Assenmacher J, Levy MS, Wen D. Open fracture of the tibia in children. J Bone Joint Surg Am. 1996;78:1039–47.

    PubMed  CAS  Google Scholar 

  12. Rodriguez-Merchan EC. Pediatric skeletal trauma: a review and historical perspective. Clin Orthop Relat Res. 2005;432:8–13.

    Article  PubMed  Google Scholar 

  13. Parfitt AM, Travers R, Rauch F, Glorieux FH. Structural and cellular changes during bone growth in healthy children. Bone. 2000;27:487–94.

    Article  PubMed  CAS  Google Scholar 

  14. Stewart DG, Kay RM, Skaggs DL. Open fractures in children. Principles of evaluation and management. JBJS. 2005;87:2784–98.

    Article  Google Scholar 

  15. Patzakis MJ, Wilkins J. Factors influencing infection rate in open fracture wounds. Clin Orthop Relat Res. 1989;243:36–40.

    PubMed  Google Scholar 

  16. Armstrong PF. Initial management of the multiply injured child: the ABC’s. Instr Course Lect. 1992;41:347–50.

    PubMed  CAS  Google Scholar 

  17. Shires GT, Jones RC. Initial management of the severely injuried patient. JAMA. 1970;213:1872–8.

    Article  PubMed  CAS  Google Scholar 

  18. Chameides L, Hazinski MF, editors. Pediatric advanced life support. Dallas: American Heart Association; 1997.

    Google Scholar 

  19. American College of Surgeons. Committee on trauma. Advanced trauma life support manual. Chicago: American College of Surgeons; 1997.

    Google Scholar 

  20. Boon JM, Gorry DL, Meiring JH. Finding an ideal site for intraosseous infusion of the tibia: an anatomical study. Clin Anat. 2003;16:15–8.

    Article  PubMed  CAS  Google Scholar 

  21. Guy J, Haley K, Zuspan SJ. Use of intraosseous infusion in the pediatric trauma patient. J Pediatr Surg. 1993;28:158–61.

    Article  PubMed  CAS  Google Scholar 

  22. Bielski RJ, Bassett GS, Fideler B, Tolo VT. Intraosseous infusions: effects on the immature physis—an experimental model in rabbits. J Pediatr Orthop. 1993;13:511–5.

    Article  PubMed  CAS  Google Scholar 

  23. Blick SS, Brumback RJ, Poka A, Burgess AR, Ebraheim NA. Compartment syndrome in open tibial fractures. J Bone Joint Surg Am. 1986;68:1348–53.

    PubMed  CAS  Google Scholar 

  24. Nord RM, Quach T, et al. Detection of traumatic arthrotomy of the knee using the saline load test. J Bone Joint Surg Am. 2009;91:66–70.

    Article  PubMed  Google Scholar 

  25. Hak DJ, Olson SA, Matta JM. Diagnosis and management of closed internal degloving injuries associated with pelvic and acetabular fractures: the Morel-Lavallee lesion. J Trauma. 1997;42:1046–51.

    Article  PubMed  CAS  Google Scholar 

  26. Tseng S, Tornetta P. Percutaneous management of Morel-Lavallee lesions. J Bone Joint Surg Am. 2006;88:92–6.

    Article  PubMed  Google Scholar 

  27. Tscherne H, Oestern H-J. A new classification of soft-tissue damage in open and closed fractures (author’s transl). Unfallheilkunde. 1982;85:111–5.

    PubMed  CAS  Google Scholar 

  28. Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am. 1976;58:453–8.

    PubMed  CAS  Google Scholar 

  29. Gustilo RB, Mendoza RM, Williams DN. Problems in the management of type III (severe) open fractures: a new classification of type III open fractures. J Trauma. 1984;24:742–6.

    Article  PubMed  CAS  Google Scholar 

  30. Zalavras CG, Patzakis MJ. Open fractures: evaluation and management. J Am Acad Orthop Surg. 2003;11:212–9.

    PubMed  Google Scholar 

  31. Skaggs DL, Kautz SM, Kay RM, Tolo VT. Effect of delay of surgical treatment on rate of infection in open fractures in children. J Pediatr Orthop. 2000;20:19–22.

    Article  PubMed  CAS  Google Scholar 

  32. Browner BD. Skeletal trauma. 4th ed. Philadelphia: W.B. Saunders Co; 2008.

    Google Scholar 

  33. Khatod M, Botte MJ, Hoyt DB, Meyer RS, Smith JM, Akeson WH. Outcomes in open tibia fractures: relationship between delay in treatment and infection. J Trauma. 2003;55:949–54.

    Article  PubMed  Google Scholar 

  34. Adili A, Bhandari M, Schemitsch EH. The biomechanical effect of highpressure irrigation on diaphyseal fracture healing in vivo. J Orthop Trauma. 2002;16:413–7.

    Article  PubMed  Google Scholar 

  35. Anglen JO. Comparison of soap and antibiotic solutions for irrigation of lower-limb open fracture wounds. A prospective, randomized study. J Bone Joint Surg Am. 2005;87:1415–22.

    Article  PubMed  Google Scholar 

  36. Bhandari M, Adili A, Schemitsch EH. The efficacy of low-pressure lavage with different irrigating solutions to remove adherent bacteria from bone. J Bone Joint Surg Am. 2001;83:412–9.

    Article  PubMed  Google Scholar 

  37. Green NE, Swiontkowski MF. Skeletal trauma in children. 4th ed. Philadelphia: Elsevier; 2008.

    Google Scholar 

  38. Roberts CS, Pape HC, et al. Damage control orthopaedics. J Bone Joint Surg Am. 2005;87:434–49.

    Google Scholar 

  39. Srivastava AK, Mehlman CT, Wall EJ, Do TT. Elastic stable intramedullary nailing of tibial shaft fractures in children. J Pediatr Orthop. 2008;28:152–8.

    Article  PubMed  Google Scholar 

  40. Kubiak EN, Egol KA, Scher D, et al. Operative treatment of tibial fractures in children: are elastic stable intramedullary nails an improvement over external fixation? J Bone Joint Surg Am. 2005;87:1761–8.

    Article  PubMed  Google Scholar 

  41. Qidwai S. Intramedullary Kirschner wiring for tibia fractures in children. J Pediatr Orthop. 2001;21:294–7.

    Article  PubMed  CAS  Google Scholar 

  42. Goodwin RC, Gaynor T, Mahar A, Oka R, Lalonde FD. Intramedullary flexible nail fixation of unstable pediatric tibial diaphyseal fractures. J Pediatr Orthop. 2005;25:570–6.

    Article  PubMed  Google Scholar 

  43. Mooney JF, Argenta LC, Marks MW, Morykwas MJ, DeFranzo AJ. Treatment of soft tissue defects in pediatric patients using the V.A.C.™ system. Clin Orthop Rel Res. 2000; 376:26–31.

    Article  Google Scholar 

  44. Gopal S, Majumder S, Batchelor AG, Knight SL, De Boer P, Smith RM. Fix and flap: the radical orthopaedic and plastic treatment of severe open fractures of the tibia. J Bone Joint Surg Br. 2000;82:959–66.

    Article  PubMed  CAS  Google Scholar 

  45. Dellinger EP, Caplan ES, Weaver LD, et al. Duration of preventive antibiotic administration for open extremity fractures. Arch Surg. 1988;123:333–9.

    Article  PubMed  CAS  Google Scholar 

  46. Holtom PD. Antibiotic prophylaxis: current recommendations. J Am Acad Orthop Surg. 2006;14:S98–S100.

    PubMed  Google Scholar 

  47. Wilkins J, Patzakis M. Choice and deuration of antibiotics in open fractures. Orthop Clin North Am. 1991;22(3):433–7.

    PubMed  CAS  Google Scholar 

  48. Lavellea WF, Uhla R, Krievesb M, Drvaricc DM. Management of open fractures in pediatric patients: current teaching in accreditation council for graduate medical education (ACGME) accredited residency programs. J Pediatr Orthop B. 2008;17(1):1–6.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopedics, St. Christopher’s Hospital for Children, 3601 A Street, Philadelphia, PA, 19134, USA

    Joseph Rosenblatt DO (Clinical Instructor of Pediatric Orthopedic Surgery)

  2. Department of Orthopedics, St. Christopher’s Hospital for Children, Erie Avenue at Front Street, Philadelphia, PA, 19134, USA

    Shannon D. Safier MD (Assistant Professor of Pediatric Orthopedic Surgery)

Authors
  1. Joseph Rosenblatt DO
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shannon D. Safier MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shannon D. Safier MD .

Editor information

Editors and Affiliations

  1. , Dept. of Orthopedics, University of Maryland School of Medicin, Texas Station Court, Suite 300 1, Timonium, 21093, Maryland, USA

    Joshua M. Abzug

  2. , Orthopedic Center for Children, St. Christopher's Hospital for Children, A Street, Suite 133-1 3601, Philadelphia, 19134-1095, Pennsylvania, USA

    Martin J. Herman

Rights and permissions

Reprints and permissions

Copyright information

© 2012 Springer Science+Business Media New York

About this chapter

Cite this chapter

Rosenblatt, J., Safier, S.D. (2012). Open Tibia Fractures in Children and Adolescents. In: Abzug, J., Herman, M. (eds) Pediatric Orthopedic Surgical Emergencies. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-8005-2_10

Download citation

  • DOI: https://doi.org/10.1007/978-1-4419-8005-2_10

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4419-8004-5

  • Online ISBN: 978-1-4419-8005-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation