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Trauma

ORTHO-PLASTIC MANAGEMENT IN LOWER LIMB PAEDIATRIC TRAUMA WITH BONE AND SOFT-TISSUE LOSS AND HEALTH-RELATED QUALITY OF LIFE

British Limb Reconstruction Society (BLRS) Annual Conference, Southampton, March 2018



Abstract

Purpose

To examine the management and outcome of patients suffering complex paediatric lower limb injuries with bone and soft tissue loss.

Method

A retrospective review was conducted identifying patients from our trauma database. Inclusion criteria were age (4–17 years) and open lower-limb trauma. Outcome measures included time to soft tissue coverage, surgical techniques, trauma impact scores, health-related quality of life, union and complication rates.

Results

We identified 26 patients. 24 patients had open tibia fractures including 10 patients with bone loss. In 9 patients primary skin closure was achieved by acute shortening. 17 patients required soft tissue coverage including 14 free vascularised muscle flaps (89% within 48 hours). The surgical techniques applied were: circular fine wire frame (16), external fixateur (5) and open reduction internal fixation (5). Median follow up time was 8 (3–45) months. The trauma impact scores showed one in three patients were at risk of PTSD. All fractures went on to unite over a median time of 4.2 (2–9) months. No deep infections occurred.

Conclusion

All our patients had limb salvage, fracture union and near normal levels of physical scores in the short term. Close psychological follow up is advisable to minimise the risk of PTSD.


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