OPEN FRACTURE IN CHILDREN
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.
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.
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.