{"title":"Are Open Distal Tibia Fractures More Severe Injuries Than Open Tibial Shaft Fractures in Children?","authors":"Taylor K Zak, Ivy Nguyen, Christine A Ho","doi":"10.1097/BPO.0000000000003013","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The purpose of this study was to compare a cohort of pediatric open distal tibia fractures to open tibial shaft fractures regarding demographics and treatment outcomes.</p><p><strong>Methods: </strong>This is a retrospective review of 39 open distal tibia fractures (D group) and 55 open tibia shaft fractures (S group), treated from January 2007 to May 2017 at a single level 1 pediatric trauma center. Mann-Whitney test was used to compare means between groups.</p><p><strong>Results: </strong>There was no statistically significant difference between the 2 groups regarding demographics, injury mechanism, or injury severity scores. While the D group had nearly 4x times the rate of open reduction internal fixation (ORIF) compared with the S group [15% (6/39) vs. 4% (2/54)] and twice the rate of external fixation [15% (6/39) vs. 7% (4/54)], these were not statistically significant (P>0.05). D group had more Gustilo-Anderson type III open fractures compared with S group [46% (18/39) vs. 26% (14/54), P=0.04], longer mean operative times (2.5 vs. 2.1 h, P=0.04), longer hospitalization (8.7 vs. 6.5 d, P=0.01), and longer time to full weight-bearing (11.4 vs. 7.2 wk, P=0.03). Postoperative complications (delayed union, limb length discrepancy, infection) were similar between the 2 groups, although D group had nearly twice the rate of return to the operating room after index surgery [49% (19/39) vs. 26% (14/54), P=0.03]. Although over twice as many fractures in D group required a free flap compared with S group [18% (7/39) vs. 7% (4/54)], this did not reach statistical significance (P>0.05). Two patients in each group eventually underwent amputation; all patients had Gustilo-Anderson IIIB or IIIC fractures. Radiographic angulation at final follow-up was similar between the 2 groups (P>0.05).</p><p><strong>Conclusions: </strong>This study highlights the challenges in treating open distal tibia fractures compared with open tibial shaft fractures. Families should be counselled on a possibly prolonged treatment course, both inpatient and postoperatively, when patients sustain an open distal tibia fracture.</p><p><strong>Level of evidence: </strong>Level III-retrospective comparative study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.4000,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Pediatric Orthopaedics","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/BPO.0000000000003013","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0
Abstract
Background: The purpose of this study was to compare a cohort of pediatric open distal tibia fractures to open tibial shaft fractures regarding demographics and treatment outcomes.
Methods: This is a retrospective review of 39 open distal tibia fractures (D group) and 55 open tibia shaft fractures (S group), treated from January 2007 to May 2017 at a single level 1 pediatric trauma center. Mann-Whitney test was used to compare means between groups.
Results: There was no statistically significant difference between the 2 groups regarding demographics, injury mechanism, or injury severity scores. While the D group had nearly 4x times the rate of open reduction internal fixation (ORIF) compared with the S group [15% (6/39) vs. 4% (2/54)] and twice the rate of external fixation [15% (6/39) vs. 7% (4/54)], these were not statistically significant (P>0.05). D group had more Gustilo-Anderson type III open fractures compared with S group [46% (18/39) vs. 26% (14/54), P=0.04], longer mean operative times (2.5 vs. 2.1 h, P=0.04), longer hospitalization (8.7 vs. 6.5 d, P=0.01), and longer time to full weight-bearing (11.4 vs. 7.2 wk, P=0.03). Postoperative complications (delayed union, limb length discrepancy, infection) were similar between the 2 groups, although D group had nearly twice the rate of return to the operating room after index surgery [49% (19/39) vs. 26% (14/54), P=0.03]. Although over twice as many fractures in D group required a free flap compared with S group [18% (7/39) vs. 7% (4/54)], this did not reach statistical significance (P>0.05). Two patients in each group eventually underwent amputation; all patients had Gustilo-Anderson IIIB or IIIC fractures. Radiographic angulation at final follow-up was similar between the 2 groups (P>0.05).
Conclusions: This study highlights the challenges in treating open distal tibia fractures compared with open tibial shaft fractures. Families should be counselled on a possibly prolonged treatment course, both inpatient and postoperatively, when patients sustain an open distal tibia fracture.
Level of evidence: Level III-retrospective comparative study.
期刊介绍：
Journal of Pediatric Orthopaedics is a leading journal that focuses specifically on traumatic injuries to give you hands-on on coverage of a fast-growing field. You''ll get articles that cover everything from the nature of injury to the effects of new drug therapies; everything from recommendations for more effective surgical approaches to the latest laboratory findings.
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