Open Access, Peer-reviewed
pISSN 1226-2102
eISSN 2005-8918
    J Korean Orthop Assoc. 2010 Dec;45(6):440-447. Korean.
    Published online Dec 24, 2010.
    https://doi.org/10.4055/jkoa.2010.45.6.440
    Copyright © 2010 by The Korean Orthopaedic Association
    Original Article

    Analysis of Treatment Outcomes for Open Fractures of the Tibia in Children

    Jong-Hyuk Park, M.D., Jung Ryul Kim, M.D., Ph.D., Dong Hun Ham, M.D., Hyung Suk Lee, M.D. and Sung Jin Shin, M.D.*
      • Department of Orthopedic Surgery, Chonbuk National University, Medical School Research Institute of Clinical Science, Korea.
      • *Department of Orthopaedic Surgery, Jeju National University College of Medicine, Jeju, Korea.
    • Correspondence to: Jung Ryul Kim, M.D., Ph.D. Department of Orthopedic Surgery, Chonbuk National University Medical School, 634-18, Geumam-dong, Dugjin-gu, Jeonju 561-712, Korea. TEL: +82-63-250-1767, FAX: +82-63-271-6538 Email: jrkeem@chonbuk.ac.kr
    Received December 16, 2010; Accepted May 10, 2010.

    This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

    Abstract

    Purpose

    Our objective was to analyze outcomes of treatment for open fractures of the tibia in children according to the classification of Gustilo-Anderson type.

    Materials and Methods

    We reviewed thirty five pediatric patients who underwent surgery for open fractures of the tibia between June 1998 and June 2007. We followed up over more than 1 year. Fractures were grouped into three types according to Gustilo-Anderson classification (Types I, II, and III). External fixation or flexible intramedullary nailing was used as the surgical method. We analyzed the period required to achieve radiologic bony union, tibial alignment, leg length discrepancy and complications. Clinical outcomes were assessed using the Karlstrom-Olerud method.

    Results

    Radiologically, bony union was achieved in 11.35±3.08 weeks, 10.50±2.20 weeks, and 21.62±7.19 weeks for types I, II, and III, respectively. Delayed union occurred in one case of type II and 3 cases of type III fractures. Complications such as nonunion, malunion and osteomyelitis were seen only in type III. Clinical outcomes showed excellent or good results in all cases except one (type III).

    Conclusion

    Excellent outcomes for open fractures of the tibia in children can be obtained regardless of Gustilo-Anderson type when adequate procedures are performed.

    Keywords
    tibia; open fracture; children

    Figures

    Figure 1
    (A) A 15-year-old female sustained open fracture of the tibia and fibula in Gustilo-Anderson type IIIA combined with brain injury. (B) At 4 weeks later, closed reduction and internal fixation with flexible intramedullary nail was performed. (C) Rotational deformity (40 degrees of external rotation) occurred at the 6-month follow up. (D) Deformity correction with external fixator was performed. (E) The photograph and radiograph at the last follow up show complete bony union and correction of rotational deformity.

    Figure 2
    (A) A 5-year-old male sustained open fracture of the tibia in Gustilo-Anderson type IIIC caused by traffic accident. (B) Closed reduction and external fixation with mono-fixator was performed. (C) However, extensive soft tissue infection and infected nonunion developed. (D) After resection of infected bone fragment, acute compression and lengthening procedure with Ilizarov apparatus was performed at the proximal tibia. (E) Excellent bone union was observed at the last follow-up.

    Figure 3
    This graph shows distribution of functional outcomes according to Gustilo-Anderson types. Excellent or good grade was achieved in all cases except one.

    Figure 4
    This graph shows distribution of functional outcomes according to treatment methods such as an external fixator and flexible IM nailing. There was no significant deference between the external fixator and flexible IM nailing.

    Tables

    Table 1
    Patients' Data and Results

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    MeSH Terms
    Child
    Fracture Fixation, Intramedullary
    Fractures, Open
    Humans
    Leg
    Osteomyelitis
    Tibia
    Metrics
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