All studies from these searches were then reviewed. Reference lists from the articles retrieved were further scrutinized to identify any additional studies of interest. We searched the Medline, EMBASE, and Cochrane computerized literature databases from January 1980 to June 2008 for articles containing the following terms: open tibia fracture(s), children, treatment(s), and outcome(s). Our study was carried out to answer the following questions: first, how has the treatment pattern for open fractures of the tibia evolved in a pediatric population (<18 years) during the past three decades based on their Gustilo types? second, what is the comparative risk of infection in different sub-types of open tibial fractures? third, is there any difference in time to fracture healing for different types of open tibia fractures in pediatric population? However, many of these studies have low numbers, and as such, it is difficult to show a statistically significant difference, even though one almost certainly exists. Most of the available literature seems to indicate that higher Gustillo type fractures (in adults and children) tend to have more complications and less predictable outcomes.
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Although some clinicians purport that these injuries may behave similarly in children and adults, others feel that these injuries are better tolerated in children, particularly young children. Open fractures of the tibia in a pediatric population can be associated with notable morbidity, including but not limited to compartment syndrome, deep infection, non union, and even amputation.
While patients are under anesthesia, the clinician can easily be convinced to opt for some sort of operative stabilization (either with internal or external fixation) if moderate or severe soft tissue injuries are present.
Interestingly, the changing pattern of injuries with progressive urbanization, the increasing social demand on children to return early to active athletics and sports, and pressure from parents and family for the clinician to obtain early, fast, and perfect results could potentially bias clinicians towards operative fixation of these fractures in some cases.Īdvances in knowledge in the areas of bacteriology and microbiology, antibiotics, and wound care have propagated a current era of thorough debridement under anesthesia with wound irrigation and antibiotics. These characteristics have long provided surgeons with the option to manage these fractures by irrigation and debridement followed by casting. The biology of these fractures in children differs notably from that in adults due to the presence of a thick periosteum, of better vascularity, better healing ability, and improved potential to remodel. Internal fixation, especially with intramedullary devices, is an emerging technique that has rapidly gained popularity over the past decade. Traditional methods of managing these fractures, such as closed treatment with plaster casts, have evolved from open irrigation and debridement, casting, either isolated or with pins and plaster and, more recently, external or internal fixation methods. Auto banishing works only if useBlackSkull set to negative.The management of open fractures of the tibia in the pediatric population is a challenging problem. (dailyFragsToRedSkull + dailyFragsToBanishment) with their NOTE: *Banishment and *BlackSkull variables are >summed up< esmas yo hace un tiempo abri un servidor con el mismo server pero era 8.50 y me marcho todo bien te dejo mi CONFIG.LUA Tengo los puertos abiertos los UDP y TCP de cada uno y mi IP es correcto en la cuenta nose pork el error.