Godfrey Jenna, Choi Paul D, Shabtai Lior, Nossov Sarah B, Williams Amy, Lindberg Antoinette W, Silva Selina, Caird Michelle S, Schur Mathew D, Arkader Alexandre
Children's Hospital Los Angeles, Los Angeles, CA.
Shriner's Hospital for Children.
J Pediatr Orthop. 2019 Aug;39(7):372-376. doi: 10.1097/BPO.0000000000000972.
The management of pediatric type I open fractures remains controversial. The aim of this study is to compare outcomes in type I open fractures managed with superficial wound debridement and antibiotics in the emergency department (ED) (nonoperative management) to patients managed with operative debridement and antibiotics (operative management).
A multicenter retrospective review was performed of all pediatric type I open forearm, wrist, and tibia fractures treated at 4 high volume pediatric centers between 2000 and 2015. Patients with multiple traumatic injuries, immunocompromised patients, or those without final radiographs indicating healing were excluded.
In total, 219 patients met inclusion criteria. A total of 170 fractures were treated operatively (77.6%), 49 fractures were treated nonoperatively (22.4%). There was 1 infection in the nonoperative group (2.0% infection rate), and no infections in the operatively managed group (P=0.062). Cefazolin was the most commonly administered antibiotic (88.1% of patients). Duration of hospital-administered antibiotics was significantly different, with a mean of 10.9 hours in the nonoperative group and 41.6 hours in the operative group (P<0.001). Length of stay averaged 16.3 hours for nonoperative patients and 48.6 hours for the operatively treated patients (P<0.001). In the nonoperative group, 44/49 had documented superficial wound debridement in the ED utilizing, on an average, 1500 mL of irrigant. There were 10 other complications, 9 in the operative group (5.4%) and 2 in the nonoperative group (4.1%, P=0.107), including 2 compartment syndromes and 1 acute carpal tunnel syndrome all requiring immediate surgical release (1.8%) in the operative group.
There was no significant difference in infection rate or complication rate in those managed with antibiotics and operative debridement versus those managed with superficial wound debridement and antibiotics in the ED. Consideration should be given to the similar safety profiles for these 2 treatment modalities when managing pediatric patients with type I open fractures.
Level III.
小儿I型开放性骨折的治疗仍存在争议。本研究的目的是比较在急诊科（ED）采用浅表伤口清创术和抗生素治疗（非手术治疗）与采用手术清创术和抗生素治疗（手术治疗）的I型开放性骨折患者的治疗结果。
对2000年至2015年间在4家大型儿科中心接受治疗的所有小儿I型开放性前臂、腕部和胫骨骨折进行多中心回顾性研究。排除有多处创伤性损伤的患者、免疫功能低下的患者或最终X线片未显示愈合的患者。
共有219例患者符合纳入标准。其中170例骨折接受了手术治疗（77.6%），49例骨折接受了非手术治疗（22.4%）。非手术组有1例感染（感染率2.0%），手术治疗组无感染（P=0.062）。头孢唑林是最常用的抗生素（88.1%的患者使用）。医院使用抗生素的时间有显著差异，非手术组平均为10.9小时，手术组为41.6小时（P<0.001）。非手术患者的平均住院时间为16.3小时，手术治疗患者为48.6小时（P<0.001）。在非手术组中，49例中有44例在急诊科进行了浅表伤口清创，平均使用1500 mL冲洗液。还有10例其他并发症，手术组9例（5.4%），非手术组2例（4.1%，P=0.107），包括2例骨筋膜室综合征和1例急性腕管综合征，手术组所有这些病例均需立即手术松解（1.8%）。
在ED中，采用抗生素和手术清创治疗与采用浅表伤口清创和抗生素治疗的患者在感染率或并发症率方面无显著差异。在治疗小儿I型开放性骨折患者时，应考虑这两种治疗方式具有相似的安全性。
III级。
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