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British Medical Bulletin Advance Access originally published online on May 27, 2009
British Medical Bulletin 2009 91(1):75-85; doi:10.1093/bmb/ldp019
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© The Author 2009. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org

Open tibial fractures in the paediatric population: a systematic review of the literature

Nikolaos Gougoulias, Anil Khanna and Nicola Maffulli*

Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, London, UK

* Correspondence to: Nicola Maffulli, Centre for Sports and Exercise Medicine Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London E1 4DG UK Email: n.maffulli{at}qmul.ac.uk

Introduction: Open tibial fractures have been studied extensively in adults, and detailed treatment strategies have been developed: wound irrigation and debridement, fracture stabilization and delayed primary wound closure or early flap coverage are basic principles of management. No clear guidelines regarding the management of open tibial fractures in children exist.

Sources of data: We searched Medline, Embase, Cochrane, CINAHL and Google Scholar databases using the keywords: ‘open’, ‘tibia’, ‘fracture’, ‘children’, ‘paediatric’, ‘pediatric’, ‘external fixation’, ‘nailing’. Fourteen clinical studies were included. Quality of the studies was assessed using the Coleman Methodology Score.

Areas of agreement: Age above 10 years and grade III (severe) open fractures are associated with complications and outcomes similar to those in adults.

Areas of controversy: It is unclear whether open fractures of the tibia in children should be managed according to the principles followed in adults. Many authors support primary skin closure and non-operative management for grade I open fractures. There is no clear effect of fracture fixation method on time to union.

Growing points: The quality of the studies was relatively poor. Patients' age affects outcome; adolescents should probably be managed as adults.

Areas timely for developing research: Carefully designed prospective cohort studies including a large number of children would be of value. Adequate follow-up is necessary to assess the long-term effects in the growing skeleton. The efficacy of flexible intramedullary nailing for open fractures needs further evaluation. Outcome studies based on general health measures are needed.

Keywords: open • fracture • tibia • children • paediatric

Accepted for publication April 28, 2009.


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