Nonoperative versus operative management of pediatric type 1 open fractures.

Purpose: To compare outcomes, including complications and admission status of pediatric type I open fractures treated operatively versus nonoperatively, and to expand on a previously published analysis regarding the efficacy and safety of nonoperative treatment of pediatric type I open fractures by this group.

Methods: Retrospective chart review via ICD-9 and ICD-10 codes correlated with type 1 open fractures of long bones at our Level 1 Children's Hospital from 2000 to 2020. Nonoperative management included IV antibiotics and closed reduction and immobilization under sedation. Operative management included formal I&D and ORIF. Demographics, antibiotic administration, hospitalization, and complications were compared using independent t test, and chi-squared or fisher exact test. Radiographic healing was analyzed.

Results: Ninety patients met inclusion criteria [52 nonoperative (NO), 38 operative (OR)] (Table 1). Patients were treated predominately with cefazolin (NO 85.7%, OR 71.4%). Nonoperative patients were more frequently given oral antibiotics (NO 82.7%, OR 44.7%, p value 0.004). Those treated operatively were more frequently admitted (71.1% vs. 25%, p < 0.001). There were three deep infections in the operative cohort requiring repeat operative I&D (p 0.110) (Table 2). There were more incisional infections (7.9% vs. 1.9%), nonunion (2.6% vs. 0%), and ED visits/readmissions (10.5% vs. 3.8%) in the operative cohort. Loss of reduction was more common in the nonoperative cohort (9.6% vs. 5.2%), and refracture/peri-implant fracture in the operative (10.5% vs. 0%). Comparison of overall complications favored the nonoperative group (p = 0.037, Table 3).

Conclusions: Nonoperative management is a safe and effective treatment of pediatric type I open fractures, including decreased hospital admission and elimination of anesthesia risks.

Level iii evidence: Retrospective comparative study.