THE EARLY RESULTS OF IMMEDIATE INTERNAL FIXATION OF OPEN FRACTURES IN CHILDREN

Results of twenty five open fractures in twenty three patients between the years 1989-1996 were reviewed. The patients were between three and fifteen years old (mean age 10). Thirteen of the cases were male (57%), ten of them were female (43%). The average follow-up period was one year. Of 23 patients, 14 (60.9%) had been injured in motor vehicle accidents, and 43.3% per cent had associated injuries. Four (16%) fractures were graded as Grade I, five (20%) Grade II and sixteen (64%) Grade III open fractures according to the classification of Gustilo. Seventeen patients had lower extremity fractures and eight had upper extremity fractures. Twenty two patients were treated with immediate debridement, irrigation, open reduction and internal fixation and three (13%) Grade IIIC open fractures were treated with amputation. All patients received intravenous antibiotic treatment at the emergency room. Fourteen (60.9%) patients needed a second operation for soft tissue reconstruction. On follow-up, one (4.3%) patient died, one (4.3%) patient had acute renal failure, three (13%) had soft tissue infections and four (17%) had some restriction of range of joint motion. Open reduction and internal fixation with careful debridement and irrigation has positive effects on the early results in children with open fractures.

ÇOCUK AÇIK KIRIKLARINDA AÇIK REDÜKSÝYON VE ÝNTERNAL TESPÝTÝN ERKEN SONUÇLARI

1989-1992 yýllarý arasýnda 25 adet açýk kýrýðý tedavi edildi. Hastalarýn yaþ ortalamasý 10 (3-15 olup, ortalama izleme süresi 1 yýl (6ay-2 yýl) idi. Olgularýmýzýn 13'ü (%57) erkek, 10'u (%43) kýz çocuðu idi. Olgularýn %60,9'unda açýk kýrýklarýn nedeni trafik kazasý olup, %43.3'ünde birlikte diðer yaralanmalar vardý. Gustilo'nun sýnýflamasýna göre kýrýklarýn 4'ü (%16) tip I, 5'i (%20) tip II, 16'sý (%64) tip III açýk kýrýklar olup 17'si (%68) alt, 8'i (%32) üst ekstremiteye ait idi. Tip III C açýk kýrýðý olan ve ilk tedavi olarak amputasyon uygulanan hasta dýþýndakilere debridman, irrigasyon, açýk redüksiyon ve internal tesbit uygulandý. Tüm olgulara ilk deðerlendirmelerinden sonra koruyucu intravenöz antibiotik uygulanmasýna baþlandý. Ondört (%60.9) hastaya yumuþak doku onarýmý için tekrar ameliyat yapýldý. Komplikasyon olarak; 1 (%4.3) ölüm, 1 (%4.3) akut böbrek yetmezliði, 3 (%13) yumuþak doku enfeksiyonu ve 4 (%17) olguda eklem hareket kýsýtlýðý saptandý. Olgularýn hiçbirisinde ostemiyelit, kaynamama, kaynama gecikmesi, kötü kaynama, eksremite uzunluk farký saptanmadý. Çocuk açýk kýrýklarýnýn cerrahi tedavisinde açýk redüksiyon ve internal tesbit yönteminin, dikkatli debridman ve irrigasyonla birlikte kullanýlmasý olgularýn erken dönem sonuçlarý üzerinde olumlu etkisi olmaktadýr.