Rakowski Dylan R, Roper Brennan, Purtell Sarah R, Carry Patrick, Sanders Julia S
University of Colorado School of Medicine, Department of Orthopedics, Aurora, CO, USA.
University of Texas, Department of Orthopedic Surgery, Houston, TX, USA.
J Pediatr Soc North Am. 2025 Mar 7;11:100167. doi: 10.1016/j.jposna.2025.100167. eCollection 2025 May.
Tibia fractures are the third most common pediatric long bone fractures and are associated with numerous complications such as compartment syndrome, angular deformity, and nonunion. This study sought to determine if complication rates were higher in open tibia fractures than in closed tibia fractures in the pediatric population, with the hypothesis that there would be no difference.
A single-center, retrospective cohort study was performed at a quaternary care academic pediatric hospital identifying all open tibia fractures treated from March 1, 2016, to November 30, 2021. These patients were matched by sex, age, and injury pattern, with patients treated for closed tibia fractures during this same time period. Data collected included demographics, clinical and radiographic information, and complications.
Both fracture groups included 30 patients (24 males and 6 females). The average age at injury was 11.3 years in the open group, and 11.2 years in the closed group. The median follow-up duration was 7.7 months (1.2-67.8 months) and 9.3 months (1.4-62.9 months) for the open and closed groups, respectively, ( = .5749). One hundred percent of open fractures were treated operatively, versus 50% of the closed-group ones ( < .0001). There was no significant difference in any type of complications when comparing the open group to the closed tibia fracture group (odds ratio: 1.29, 95% confidence interval: 0.48 to 3.45, = .6180). The most common complication was the development of a clinically significant angular deformity (26.7% in the open group and 10% in the closed group, = .1806). There was a 10% rate of compartment syndrome in both groups and a nonunion rate of 6.7% for the open group and 3.3% for the closed group ( > .999).
This pilot study utilizing a matched cohort found no significant difference in complication rates between open and closed pediatric tibia fractures, though complications were prevalent in both groups. These findings emphasize the importance of maintaining a high clinical suspicion for compartment syndrome and thoroughly counseling patients on the risks of angular deformity.
(1) A matched cohort study demonstrates complication rates are similarly high in both open and closed pediatric tibial shaft fractures.(2) Angular deformity is the most common complication overall.(3) Treatment algorithms may differ in open versus closed tibial shaft fractures, with open fractures fixated with different constructs and immobilized for longer.
Level III, case control study.
胫骨骨折是儿童第三常见的长骨骨折，常伴有多种并发症，如骨筋膜室综合征、成角畸形和骨不连。本研究旨在确定儿童开放性胫骨骨折的并发症发生率是否高于闭合性胫骨骨折，研究假设为两者无差异。
在一家四级医疗学术儿童医院进行了一项单中心回顾性队列研究，纳入2016年3月1日至2021年11月30日期间治疗的所有开放性胫骨骨折患者。这些患者按照性别、年龄和损伤模式，与同期治疗的闭合性胫骨骨折患者进行匹配。收集的数据包括人口统计学信息、临床和影像学资料以及并发症情况。
两组骨折患者均为30例（男性24例，女性6例）。开放性骨折组的平均受伤年龄为11.3岁，闭合性骨折组为11.2岁。开放性骨折组和闭合性骨折组的中位随访时间分别为7.7个月（1.2 - 67.8个月）和9.3个月（1.4 - 62.9个月）（P = 0.5749）。所有开放性骨折均接受手术治疗，而闭合性骨折组的手术治疗率为50%（P < 0.0001）。比较开放性骨折组和闭合性胫骨骨折组，各类并发症发生率无显著差异（优势比：1.29，95%置信区间：0.48至3.45，P = 0.6180）。最常见的并发症是出现具有临床意义的成角畸形（开放性骨折组为26.7%，闭合性骨折组为10%，P = 0.1806）。两组骨筋膜室综合征发生率均为10%，开放性骨折组骨不连发生率为6.7%，闭合性骨折组为3.3%（P > 0.999）。
这项采用匹配队列的初步研究发现，儿童开放性和闭合性胫骨骨折的并发症发生率无显著差异，尽管两组并发症都很常见。这些发现强调了对骨筋膜室综合征保持高度临床怀疑以及向患者充分告知成角畸形风险的重要性。
（1）匹配队列研究表明，儿童开放性和闭合性胫骨干骨折的并发症发生率同样高。（2）成角畸形是总体上最常见的并发症。（3）开放性和闭合性胫骨干骨折的治疗方案可能不同，开放性骨折采用不同的固定方式且固定时间更长。
三级，病例对照研究。
