Are Open Distal Tibia Fractures More Severe Injuries Than Open Tibial Shaft Fractures in Children?

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.