TREATMENT MANAGEMENT FOR PEDIATRIC OPEN FRACTURES

Although the mechanism of formation and frequency of open fractures are different in children and adults, their treatments can be similar in these two populations. The most common open fractures in children concern the hand and upper extremity and are mostly caused by falls. Similar treatment steps as in adults should be carefully considered. Treatment should be initiated in a multidisciplinary manner in the emergency department, the patient’s vital functions should be assessed, and then the open frac-ture should be focused on. Early antibiotics and tetanus prophylaxis should be carefully evaluated. The Gustilo and Anderson system is still the most widely used classification for open fractures in children and adults. Although there are controversial issues in the classification, treatment steps and evaluation, a general consensus has been reached. Antibiotic therapy is the most important treatment step in pro-tecting against known infection, and early antibiotics have been determined to be more effective than debridement. Except for some type I open fractures, all open fractures require emergency surgery and may require routine debridement, while pediatric open fractures can be successfully treated with a sin-gle debridement and loose wound closure. Preoperative and post-debridement cultures may be useful in determining the infectious agent. In the presence of a soft tissue defect, wounds should be closed with skin grafts, soft tissue transfers, and rotational flaps. With the negative pressure applied with vacuum-assisted devices, significant advances have been made in the treatment of soft tissue losses in children as in adults. When soft tissue coverage reaches the desired level, bone reconstruction should be planned in a way that will not cause further loss of soft tissue coverage. When wound debridement is deemed sufficient, fracture stabilization should be provided. Fracture stabilization in children is usually achieved with a splint supported by a percutane wire. External fixation may be necessary if there is a major soft tissue injury. Gunshot wounds are increasingly common in children and cause extensive contamination and fragmented fractures. Wounds caused by agricultural machinery inherently produce extremely contaminated wounds. Agricultural injuries require interventions that require multiple de-bridements until debris is removed and healthy granulation tissue is visible. In addition to debridement, broad-spectrum antibiotics should be used to cover anaerobic infections. If amputation is necessary, amputation should be done as distal as possible.