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.

Open tibial fractures in the paediatric population: a systematic review of the literature / Gougoulias, N; Khanna, A; Maffulli, Nicola. - In: BRITISH MEDICAL BULLETIN. - ISSN 0007-1420. - (2009), pp. 75-85.

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

MAFFULLI, Nicola
2009

Abstract

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.
2009
01 Pubblicazione su rivista::01a Articolo in rivista
Open tibial fractures in the paediatric population: a systematic review of the literature / Gougoulias, N; Khanna, A; Maffulli, Nicola. - In: BRITISH MEDICAL BULLETIN. - ISSN 0007-1420. - (2009), pp. 75-85.
File allegati a questo prodotto
Non ci sono file associati a questo prodotto.

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1694402
 Attenzione

Attenzione! I dati visualizzati non sono stati sottoposti a validazione da parte dell'ateneo

Citazioni
  • ???jsp.display-item.citation.pmc??? ND
  • Scopus 31
  • ???jsp.display-item.citation.isi??? 27
social impact