Open Tibia Fractures in Children and Adolescents



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.


Open tibia fracture Irrigation and debridement Flexible intramedullary nails External fixation Compartment syndrome 


  1. 1.
    Kreder HJ, Armstrong P. A review of open tibia fractures in children. J Pediatr Orthop. 1995;15:482–8.PubMedCrossRefGoogle Scholar
  2. 2.
    Robertson P, Karol LA, Rab GT. Open fractures of the tibia and femur in children. J Pediatr Orthop. 1996;16:621–6.PubMedCrossRefGoogle Scholar
  3. 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.CrossRefGoogle Scholar
  4. 4.
    Zalavras CG, Marcus RE, Levin LS, Patzakis MJ. Management of open fractures and subsequent complications. JBJS. 2007;89:884–95.CrossRefGoogle Scholar
  5. 5.
    Liow RYL, Montogomery RJ. Treatment of established and anticipated nonunion of the tibia in childhood. J Pediat Orthop. 2002;22:754–60.CrossRefGoogle Scholar
  6. 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. 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.PubMedGoogle Scholar
  8. 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.PubMedGoogle Scholar
  9. 9.
    Irwin A, Gibson P, Ashcroft P. Open fractures of the tibia in children. Injury. 1995;26:21–4.PubMedCrossRefGoogle Scholar
  10. 10.
    Jones BG, Duncan RD. Open tibial fractures in children under 13 years of age—10 years experience. Injury. 2003;34:776–80.PubMedCrossRefGoogle Scholar
  11. 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.PubMedGoogle Scholar
  12. 12.
    Rodriguez-Merchan EC. Pediatric skeletal trauma: a review and historical perspective. Clin Orthop Relat Res. 2005;432:8–13.PubMedCrossRefGoogle Scholar
  13. 13.
    Parfitt AM, Travers R, Rauch F, Glorieux FH. Structural and cellular changes during bone growth in healthy children. Bone. 2000;27:487–94.PubMedCrossRefGoogle Scholar
  14. 14.
    Stewart DG, Kay RM, Skaggs DL. Open fractures in children. Principles of evaluation and management. JBJS. 2005;87:2784–98.CrossRefGoogle Scholar
  15. 15.
    Patzakis MJ, Wilkins J. Factors influencing infection rate in open fracture wounds. Clin Orthop Relat Res. 1989;243:36–40.PubMedGoogle Scholar
  16. 16.
    Armstrong PF. Initial management of the multiply injured child: the ABC’s. Instr Course Lect. 1992;41:347–50.PubMedGoogle Scholar
  17. 17.
    Shires GT, Jones RC. Initial management of the severely injuried patient. JAMA. 1970;213:1872–8.PubMedCrossRefGoogle Scholar
  18. 18.
    Chameides L, Hazinski MF, editors. Pediatric advanced life support. Dallas: American Heart Association; 1997.Google Scholar
  19. 19.
    American College of Surgeons. Committee on trauma. Advanced trauma life support manual. Chicago: American College of Surgeons; 1997.Google Scholar
  20. 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.PubMedCrossRefGoogle Scholar
  21. 21.
    Guy J, Haley K, Zuspan SJ. Use of intraosseous infusion in the pediatric trauma patient. J Pediatr Surg. 1993;28:158–61.PubMedCrossRefGoogle Scholar
  22. 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.PubMedCrossRefGoogle Scholar
  23. 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.PubMedGoogle Scholar
  24. 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.PubMedCrossRefGoogle Scholar
  25. 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.PubMedCrossRefGoogle Scholar
  26. 26.
    Tseng S, Tornetta P. Percutaneous management of Morel-Lavallee lesions. J Bone Joint Surg Am. 2006;88:92–6.PubMedCrossRefGoogle Scholar
  27. 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.PubMedGoogle Scholar
  28. 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.PubMedGoogle Scholar
  29. 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.PubMedCrossRefGoogle Scholar
  30. 30.
    Zalavras CG, Patzakis MJ. Open fractures: evaluation and management. J Am Acad Orthop Surg. 2003;11:212–9.PubMedGoogle Scholar
  31. 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.PubMedCrossRefGoogle Scholar
  32. 32.
    Browner BD. Skeletal trauma. 4th ed. Philadelphia: W.B. Saunders Co; 2008.Google Scholar
  33. 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.PubMedCrossRefGoogle Scholar
  34. 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.PubMedCrossRefGoogle Scholar
  35. 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.PubMedCrossRefGoogle Scholar
  36. 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.PubMedCrossRefGoogle Scholar
  37. 37.
    Green NE, Swiontkowski MF. Skeletal trauma in children. 4th ed. Philadelphia: Elsevier; 2008.Google Scholar
  38. 38.
    Roberts CS, Pape HC, et al. Damage control orthopaedics. J Bone Joint Surg Am. 2005;87:434–49.Google Scholar
  39. 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.PubMedCrossRefGoogle Scholar
  40. 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.PubMedCrossRefGoogle Scholar
  41. 41.
    Qidwai S. Intramedullary Kirschner wiring for tibia fractures in children. J Pediatr Orthop. 2001;21:294–7.PubMedCrossRefGoogle Scholar
  42. 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.PubMedCrossRefGoogle Scholar
  43. 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.CrossRefGoogle Scholar
  44. 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.PubMedCrossRefGoogle Scholar
  45. 45.
    Dellinger EP, Caplan ES, Weaver LD, et al. Duration of preventive antibiotic administration for open extremity fractures. Arch Surg. 1988;123:333–9.PubMedCrossRefGoogle Scholar
  46. 46.
    Holtom PD. Antibiotic prophylaxis: current recommendations. J Am Acad Orthop Surg. 2006;14:S98–S100.PubMedGoogle Scholar
  47. 47.
    Wilkins J, Patzakis M. Choice and deuration of antibiotics in open fractures. Orthop Clin North Am. 1991;22(3):433–7.PubMedGoogle Scholar
  48. 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.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  1. 1.Department of OrthopedicsSt. Christopher’s Hospital for ChildrenPhiladelphiaUSA
  2. 2.Department of OrthopedicsSt. Christopher’s Hospital for ChildrenPhiladelphiaUSA

Personalised recommendations