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47 - Pediatric Orthopedic Infections

from Part II - Pediatrics

Published online by Cambridge University Press:  15 December 2009

By
James M. Mok  and
Paul D. Choi
Edited by
Rachel L. Chin
James M. Mok
Affiliation:
Department of Orthopaedic Surgery, University of California, San Francisco School of Medicine, San Francisco General Hospital, San Francisco, CA
Paul D. Choi
Affiliation:
Assistant Clinical Professor of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Childrens Hospital Los Angeles, Los Angeles, CA
Rachel L. Chin
Affiliation:
University of California, San Francisco
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Summary

OPEN FRACTURE IN CHILDREN

Introduction

Motor vehicle accidents and falls from height account for the majority of open fractures in children. They differ from open fractures in adults in that children have greater potential for healing due to the thicker periosteum. Infection rates are also lower in children compared to adults. Open fractures in children with closed physes should receive the same treatment as in adults.

Epidemiology

Open fractures have been reported to account for 9% of fractures treated at a pediatric tertiary trauma center. Most studies show a preponderance of boys. The tibia and forearm are the areas most frequently involved.

Clinical Features

The modified Gustilo classification system is used to classify open fractures in children (Table 47.1). The overall rate of infection following open fracture in children is reported as 3%. By type, infection occurs in 2% of type I, 2% of type II, and 8% of type III fractures.

Although community-acquired methicillin-resistant Staphylococcus aureus (MRSA) is of increasing concern, no studies have been published demonstrating superior efficacy of vancomycin, clindamycin, or other antibiotics over cefazolin for open fracture. Indiscriminate use of second-tier agents may lead to increased resistance. Therefore, in the absence of a cephalosporin allergy, cefazolin is recommended as first-line prophylaxis.

Table 47.2 summarizes important clinical features of open fractures in children.

Type
Chapter
Information
Emergency Management of Infectious Diseases , pp. 283 - 290
Publisher: Cambridge University Press
Print publication year: 2008

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References

Early, S D, Kay, R M, Tolo, V T. Childhood diskitis. J Am Acad Orthop Surg 2003 Nov-Dec;11(6):413–20.CrossRefGoogle Scholar
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Chapman, M W. Chapman's orthopaedic surgery, 3rd ed. Chapter 176: Bone and joint infections in children. Philadelphia: Lippincott Williams & Wilkins, 2001.Google Scholar
Herring, J A. Tachdjian's pediatric orthopaedics, 3rd ed. Chapter 34: Bone and joint infection. Philadelphia: Saunders: Philadelphia, 2002.Google Scholar

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  • Pediatric Orthopedic Infections
    • By James M. Mok, Department of Orthopaedic Surgery, University of California, San Francisco School of Medicine, San Francisco General Hospital, San Francisco, CA, Paul D. Choi, Assistant Clinical Professor of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Childrens Hospital Los Angeles, Los Angeles, CA
  • Edited by Rachel L. Chin, University of California, San Francisco
  • Book: Emergency Management of Infectious Diseases
  • Online publication: 15 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547454.048
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  • Pediatric Orthopedic Infections
    • By James M. Mok, Department of Orthopaedic Surgery, University of California, San Francisco School of Medicine, San Francisco General Hospital, San Francisco, CA, Paul D. Choi, Assistant Clinical Professor of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Childrens Hospital Los Angeles, Los Angeles, CA
  • Edited by Rachel L. Chin, University of California, San Francisco
  • Book: Emergency Management of Infectious Diseases
  • Online publication: 15 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547454.048
Available formats
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Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • Pediatric Orthopedic Infections
    • By James M. Mok, Department of Orthopaedic Surgery, University of California, San Francisco School of Medicine, San Francisco General Hospital, San Francisco, CA, Paul D. Choi, Assistant Clinical Professor of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Childrens Hospital Los Angeles, Los Angeles, CA
  • Edited by Rachel L. Chin, University of California, San Francisco
  • Book: Emergency Management of Infectious Diseases
  • Online publication: 15 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547454.048
Available formats
×