PMID: 11915459Mar 28, 2002Paper

The reliability of the pre-operative classification of open tibial fractures in children a proposal for a new classification

Acta orthopaedica Belgica
A A Faraj

Abstract

The purpose of this observational study was to evaluate the accuracy of Gustilo's classification of open tibial fractures in children. Pre- and post-debridement (using the parameters of Gustilo's classification) wound gradings in 27 children with a mean age of 10 years (3 to 15 years) who had sustained an open tibial fracture were compared. Pre-operative Polaroid photographs of the wound were taken of all these patients in the accident and emergency department. In every case, the fracture was treated with prophylactic intravenous antibiotic administration, wound debridement and lavage. Following wound exploration in the operating theater, the wound was classified using Gustilo's parameters again; this was different from the initial grading. We compared post-debridement classification according to Gustilo to the new classification which we propose. The latter classification is a peroperative assessment of the extent of soft tissue damage and it addresses bone stability. According to this classification, the majority of open tibial fractures were stable, requiring no skin graft or flap and had a good outcome. Only five patients were treated by initial external fixation of the tibia; the remainder were treated by cast immobilizati...Continue Reading

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