DOS 2018

DOS Kongressen 2018 · 87 Debridement of open fractures in children. Vital or not, that is the question. Juozas Petruskevicius, Jan Duedal Rölfing Traumatolgy and Reconstructive Surgery Unit, Department of Orthopaedics, Aarhus University Hospital Background: Sound evidence exists regarding the management of open frac- tures in adults. In contrast, the evidence is scarce in children. The remarkable biology of the growing body makes children more resilient and tissue that ap- pears almost dead may be salvaged. However, a wrong decision resulting in in- complete debridement may deteriorate the clinical outcome. Purpose / Aim of Study: To highlight the difficulties in decision-making when debriding open fractures in children and adolescents Materials and Methods: A 14-year-old boy’s legs were crushed between the bumper of a car and a concrete block. Substantial degloving injuries with mus- cular and bony damage (Gustilo 3B) were present bilaterally with a severely comminuted tibia shaft fracture on the left leg and a 3-part tibia fracture on the right leg. Sensation was present, and pulses were weak. Findings / Results: Initial treatment consisted of antibiotics, wash out, pri- mary debridement, external fixation, photo- documentation, CT and planning. Secondary debridement took place in the presence of experts in plastic surgery and traumatology 18 hours after injury. On the worse, left side, 9 cm bony resection and bone transportation was performed via ring fixation. On the right side, an intermediate, 8 cm periosteal-stripped fragment was decided to be retained. In adults, resection would have been mandatory. After definitive treat- ment with soft tissue coverage and ring fixation, this bony fragment was com- pletely incorporate. Both legs healed without infection and with an excellent functional outcome. Conclusions: Debridement of severe open fractures is challenging. The grey area of tissue that can be salvaged is wider in children and adolescents than in adults. Expertise in advanced traumatology and plastic surgery are crucial to perform secondary debridement and to manage severe open fractures routinely. 28.