New research conducted by the Johns Hopkins Children’s Center suggests surgery is not always necessary for children with open bone fractures.
The study, published in the Journal of Children’s Orthopaedics, challenges the popular understanding that all paediatric fractures require surgery.
The results, based on the outcomes of 40 paediatric patients aged between 4 and 16, show that when the open wound is small (less than ½ an inch in diameter) and the surrounding tissue is free of contamination, children heal well on their own.
Paul Sponseller, Director of Pediatric Orthopaedics at the Johns Hopkins Children’s Centre, says that more often than not type one fractures heal on their own without infection or complications.
“Not all paediatric fractures are created equal and our findings indicate that when it comes to simple, clean open breaks, which are very common in kids, a minimalistic ‘clean, set the bone and watch’ approach could be just as effective as more aggressive surgical treatment,” said Sponseller.
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Where the traditional surgical approach requires general anesthesia and the creation of a larger wound around the broken bone, Sponseller and his team work to simply irrigate and clean the wound without further invasion of the affected area.
This nonsurgical option involves a procedure whereby the bone ends are set together before casting the limb, a process easily completed with the use of local anesthesia. Additionally, this ability to heal and clean open breaks results in less scarring and a fast recovery, not to mention lower medical costs as a result of shorter hospital stays and simpler treatment.
Although this method proves to be highly successful in clean, open breaks, Sponseller and his colleagues at Johns Hopkins caution that not all open fractures can be treated by nonsurgical repair. Fractures that induce damage on surrounding nerves or blood vessels require more elaborate surgical treatment, where Sponseller also warns that there are often cases where the bone cannot be realigned without surgery.
“The take-home lesson here is that when it comes to paediatric open fractures, a one-size treatment doesn’t fit all, and each fracture requires careful clinical evaluation,” he said.