Early and definitive treatment with ESIN, Kirschner wires, and external fixation in Gustilo and Anderson II–IIIC pediatric open fractures: A comparative study

Abstract

Objectives: Open fractures are still a significant cause of morbidity in pediatric patients. The objective of this study was to compare the safety of initial and definitive internal fixation treatment with elastic stable intramedullary nailing (ESIN), and Kirschner (K) wires, and external fixation in Type II and III Gustilo-Anderson pediatric open fractures. Methods: This was an observational, retrospective, and cross-sectional study with a non-experimental design, where all the patients who were treated for Type II-IIIC open fractures, from January 2018 to August 2021, were included in the study. Results: A total of 60 patients were included in the study, with a predominance of the male gender (61.7%, n = 37) and an average age of 8.7 years. Timing of surgery from the injury to surgical treatment was measured, with the most common interval being 12 h (13.33%, n = 8), internal fixation with K-wires was performed in 63.3% (n = 38) of the patients; and with ESIN in 30% (n = 18), with no complications, and in cases of external fixation 6.7% (n = 4) with soft-tissue infection seen in 3.33% (n = 2), associated with treatment with external fixation. Follow-up was done at 4, 6, and 12 months for the different procedures. The most frequently used antibiotics were clindamycin (35%) and cefazolin (21.67%). Conclusion: The present study supports using ESIN and K-wires as early and definitive treatment in Gustilo-Anderson Type II–IIIC pediatric open fractures. External fixation is recommended only in cases where osteosynthesis with ESIN and K-wires is not an option.