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ISSN 2306-4102 (Print)
Órgano Oficial del Colegio Mexicano de Ortopedia y Traumatología

2017, Number 1

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Acta Ortop Mex 2017; 31 (1)

Prescription pattern in the management of Type I open forearm fractures in pediatric patients

López-Tello JA, Torres-Fernández BJ, Escalona-Reynoso NG

Language: Spanish
References: 22
Page: 40-47
PDF size: 217.60 Kb.


ABSTRACT

Background: Pediatric open fractures account for more tan 10% of hospital admissions in a Pediatric Trauma Clinical Department. It is important to identify the predominant surgical management prescription pattern in pediatric patients presenting with Type I open forearm fractures at a referral center in an emerging economy. Material and methods: Observational, cross-sectional, analytical, secondary-source (logs) sampling study of consecutive cases. The cases included subjects under 17 years of age presenting with Type I open forearm fractures at a Pediatric Trauma Clinical Department from January 1st, 2009 to December 31st, 2013. Results: Ninety-two patients with a diagnosis of Type I open forearm fracture were included. All patients received parenteral antibiotics and underwent surgical debridement. However, in 69 (75%) of them a cast was used; in 9 (10%) a splint was used; 9 (10%) underwent fixation with Kirschner nails, and 5 (5.4%) underwent open reduction and internal fixation (ORIF). Eight patients (9%) required reoperation. Conclusions: Surgical management is the predominant prescription pattern in pediatric patients with Type I open forearm fracture. The latter is the predominant eepidemiology. The type of management was associated with a second surgery (p ‹ 0.000); however, this did not have a statistically significant impact on the hospital stay (p = 0.09).


REFERENCES

  1. Zalavras CG, Patzakis MJ: Open fractures: evaluation and management. J Am Acad Orthop Surg. 2003; 11(3): 212-9.

  2. Wilber JH, Thompson GH, Son-Hing J: Chapter 4. The multiply injured child. In: Green NE, Swiontkowski MF (eds.): Skeletal trauma in children. 4th edition. Philadelphia: W.B. Saunders; 2009. pp. 57-83.

  3. Stewart DG Jr, Kay RM, Skaggs DL: Open fractures in children. Principles of evaluation and management. J Bone Joint Surg Am. 2005; 87(12): 2784-98.

  4. Osornio-Ruiz JL, Martínez-Ibarra SI, Torres-González R, Reyes-Hernández RI: Lesiones traumáticas en niños que requieren hospitalización. Un serio problema de salud. Rev Med Inst Mex Seguro Soc. 2007; 45(2): 133-40.

  5. Buckley SL, Gotschall C, Robertson W Jr, Sturm P, Tosi L, Thomas M, et al: The relationships of skeletal injuries with trauma score, injury severity score, length of hospital stay, hospital charges, and mortality in children admitted to a regional pediatric trauma center. J Pediatr Orthop. 1994; 14(4): 449-53.

  6. Skaggs DL, Friend L, Alman B, Chambers HG, Schmitz M, Leake B, et al: The effect of surgical delay on acute infection following 554 open fractures in children. J Bone Joint Surg Am. 2005; 87(1): 8-12.

  7. Iobst CA, Tidwell MA, King WF: Nonoperative management of pediatric type I open fractures. J Pediatr Orthop. 2005; 25(4): 513-7.

  8. Marcus RE, Mills MF, Thompson GE: Multiple injury in children. J Bone Joint Surg Am. 1983; 65(9): 1290-4.

  9. Bartlett CS 3rd, Weiner LS, Yang EC: Treatment of type II and type III open tibia fractures in children. J Orthop Trauma. 1997; 11(5): 357-62.

  10. Gustilo RB, Anderson JT: Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am. 1976; 58(4): 453-8.

  11. Gustilo RB, Mendoza RM, Williams DN: Problems in the management of type III (severe) open fractures: a new classification of type III open fractures. J Trauma. 1984; 24(8): 742-6.

  12. Armstrong PF: Initial management of the multiply injured child: the ABC’s. Instr Course Lect. 1992; 41: 347-50.

  13. Ruíz-Martínez F, Reyes-Gallardo A, Almanza-Jiménez A, Vargas-Ávalos JA, Castillo-Torres E, Medina-Rodríguez F, et al: Nueva clasificación de las fracturas expuestas. Experiencia de 5,207 casos en el Hospital de Traumatología “Victorio de la Fuente Narváez”. Parte 1. Rev Mex Ortop Traum. 1998; 12(5): 359-71.

  14. Pace JL, Kocher MS, Skaggs DL: Evidence-based review: management of open pediatric fractures. J Pediatr Orthop. 2012; 32 Suppl 2: S123-7.

  15. Skaggs DL, Kautz SM, Kay RM, Tolo VT: Effect of delay of surgical treatment on rate of infection in open fractures in children. J Pediatr Orthop. 2000; 20(1): 19-22.

  16. Khatod M, Botte MJ, Hoyt DB, Meyer RS, Smith JM, Akeson WH: Outcomes in open tibia fractures: relationship between delay in treatment and infection. J Trauma. 2003; 55(5): 949-54.

  17. Luhmann SJ, Schootman M, Schoenecker PL, Dobbs MB, Gordon JE: Complications and outcomes of open pediatric forearm fractures. J Pediatr Orthop. 2004; 24(1): 1-6.

  18. Greenbaum B, Zionts LE, Ebramzadeh E: Open fractures of the forearm in children. J Orthop Trauma. 2001; 15(2): 111-8.

  19. Iobst CA, Spurdle C, Baitner AC, King WF, Tidwell M, Swirsky S: A protocol for the management of pediatric type I open fractures. J Child Orthop. 2014; 8(1): 71-6.

  20. Lim YJ, Lam KS, Lee EH: Open Gustilo 1 and 2 midshaft fractures of the radius and ulna in children: is there a role for cast immobilization after wound debridement? J Pediatr Orthop. 2007; 27(5): 540-6.

  21. Noyola-Cruz O, Orivio-Gallegos JA: Tratamiento de fracturas expuestas en pediatría y factores asociados [Tesis de postgrado para obtener el título de Especialista en Ortopedia]. México: UNAM. 2012.

  22. Hulley S: Diseño de las investigaciones clínicas. 3.a ed. EUA: Ed. Lippincott Williams; 2008. pp.91.




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