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Purpose <p>To compare outcomes, including complications and admission status of pediatric type I open fractures treated operatively versus nonoperatively, and to expand on a previously published analysis regarding the efficacy and safety of nonoperative treatment of pediatric type I open fractures by this group.</p> Methods <p>Retrospective chart review via ICD-9 and ICD-10 codes correlated with type 1 open fractures of long bones at our Level 1 Children’s Hospital from 2000 to 2020. Nonoperative management included IV antibiotics and closed reduction and immobilization under sedation. Operative management included formal I&amp;D and ORIF. Demographics, antibiotic administration, hospitalization, and complications were compared using independent <i>t</i> test, and chi-squared or fisher exact test. Radiographic healing was analyzed.</p> Results <p>Ninety patients met inclusion criteria [52 nonoperative (NO), 38 operative (OR)] (Table&#xa0;<InternalRef RefID="Tab1">1</InternalRef>). Patients were treated predominately with cefazolin (NO 85.7%, OR 71.4%). Nonoperative patients were more frequently given oral antibiotics (NO 82.7%, OR 44.7%, <i>p</i> value 0.004). Those treated operatively were more frequently admitted (71.1% vs. 25%, <i>p</i> &lt; 0.001). There were three deep infections in the operative cohort requiring repeat operative I&amp;D (p 0.110) (Table&#xa0;<InternalRef RefID="Tab2">2</InternalRef>). There were more incisional infections (7.9% vs. 1.9%), nonunion (2.6% vs. 0%), and ED visits/readmissions (10.5% vs. 3.8%) in the operative cohort. Loss of reduction was more common in the nonoperative cohort (9.6% vs. 5.2%), and refracture/peri-implant fracture in the operative (10.5% vs. 0%). Comparison of overall complications favored the nonoperative group (<i>p</i> = 0.037, Table&#xa0;<InternalRef RefID="Tab3">3</InternalRef>).</p> Conclusions <p>Nonoperative management is a safe and effective treatment of pediatric type I open fractures, including decreased hospital admission and elimination of anesthesia risks.</p> Level III evidence <p>Retrospective comparative study.</p>

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Nonoperative versus operative management of pediatric type 1 open fractures

  • 期刊论文

  • 发表日期：

    2025年4月13日

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  • Kevin Schauer,
  • Dylan Lis,
  • Ellen Lutnick,
  • Lauren Harte,
  • M. Nadir Haider,
  • Jeremy Doak

摘要

Purpose

To compare outcomes, including complications and admission status of pediatric type I open fractures treated operatively versus nonoperatively, and to expand on a previously published analysis regarding the efficacy and safety of nonoperative treatment of pediatric type I open fractures by this group.

Methods

Retrospective chart review via ICD-9 and ICD-10 codes correlated with type 1 open fractures of long bones at our Level 1 Children’s Hospital from 2000 to 2020. Nonoperative management included IV antibiotics and closed reduction and immobilization under sedation. Operative management included formal I&D and ORIF. Demographics, antibiotic administration, hospitalization, and complications were compared using independent t test, and chi-squared or fisher exact test. Radiographic healing was analyzed.

Results

Ninety patients met inclusion criteria [52 nonoperative (NO), 38 operative (OR)] (Table 1). Patients were treated predominately with cefazolin (NO 85.7%, OR 71.4%). Nonoperative patients were more frequently given oral antibiotics (NO 82.7%, OR 44.7%, p value 0.004). Those treated operatively were more frequently admitted (71.1% vs. 25%, p < 0.001). There were three deep infections in the operative cohort requiring repeat operative I&D (p 0.110) (Table 2). There were more incisional infections (7.9% vs. 1.9%), nonunion (2.6% vs. 0%), and ED visits/readmissions (10.5% vs. 3.8%) in the operative cohort. Loss of reduction was more common in the nonoperative cohort (9.6% vs. 5.2%), and refracture/peri-implant fracture in the operative (10.5% vs. 0%). Comparison of overall complications favored the nonoperative group (p = 0.037, Table 3).

Conclusions

Nonoperative management is a safe and effective treatment of pediatric type I open fractures, including decreased hospital admission and elimination of anesthesia risks.

Level III evidence

Retrospective comparative study.