Ramasubbu Rohan A, Ramasubbu Benjamin M
Department of Clinical Anatomy, School of Medicine, University of St. Andrews, Fife, Scotland.
Department of Emergency, Mater Hospital, Dublin, Republic of Ireland.
Indian J Orthop. 2016 Sep;50(5):455-463. doi: 10.4103/0019-5413.189613.
Management of open tibial fractures is well documented in adults, with existing protocols outlining detailed treatment strategies. No clear guidelines exist for children. Surgical stabilization of tibial fractures in the pediatric population requires implants that do not disrupt the open epiphyses (growth plate). Both elastic stable intramedullary nails and external fixation can be used. The objective of this study was to identify the optimal method of surgical stabilization in the treatment of open tibial fractures in children.
MEDLINE and Embase were searched from their inception to March 2014 using the following advanced search terms (Key words): "open tibia fracture," "fracture fixation," "external fixation," "intramedullary," and "bone nail." Only studies in English and pertaining to children with open fractures treated with elastic stable intramedullary nails or external fixation between 1994 and 2014 were included. Twelve clinical studies were critically appraised.
Due to a paucity in the literature coupled with a nonsystematic presentation of results, it proved to be very difficult in extracting relevant results from the studies. This was further added by a variation in outcome measures. Consequently, the results we obtained were difficult to draw conclusions from.
There is no conclusive evidence or best practice guidelines for their management. Thus, as is highlighted in this study, more research is needed to determine the optimum treatment strategy for this common pediatric injury. The existing literature is of poor quality; consisting mainly of retrospective reviews of patients' medical records, charts, and radiographs. Carefully designed, high-quality prospective cohort studies utilizing a nationalized multi-hospital approach are needed to improve understanding before protocols and guidelines can be developed and implemented.
成人开放性胫骨骨折的治疗已有充分记载，现有方案概述了详细的治疗策略。但针对儿童尚无明确的指南。小儿人群胫骨骨折的手术固定需要不破坏开放骨骺（生长板）的植入物。弹性稳定髓内钉和外固定均可使用。本研究的目的是确定治疗儿童开放性胫骨骨折的最佳手术固定方法。
检索MEDLINE和Embase数据库自建库至2014年3月的数据，使用以下高级检索词（关键词）：“开放性胫骨骨折”、“骨折固定”、“外固定”、“髓内”和“骨钉”。仅纳入1994年至2014年间用弹性稳定髓内钉或外固定治疗开放性骨折儿童的英文研究。对12项临床研究进行了严格评估。
由于文献匮乏且结果呈现不系统，从这些研究中提取相关结果非常困难。结果测量方法的差异进一步加剧了这一情况。因此，我们获得的结果难以得出结论。
对于其治疗尚无确凿证据或最佳实践指南。因此，正如本研究中所强调的，需要更多研究来确定这种常见小儿损伤的最佳治疗策略。现有文献质量较差；主要包括对患者病历、图表和X光片的回顾性研究。在制定和实施方案及指南之前，需要采用全国多医院方法进行精心设计、高质量的前瞻性队列研究，以增进了解。
