Open Reduction of Closed Pediatric Tibial Shaft Fractures Treated with Intramedullary Stabilization Does Not Increase Risk of Post-Operative Complications.

OBJECTIVE: To compare union and complication rates in pediatric patients presenting with tibial shaft fractures treated with closed or open reduction prior to intramedullary stabilization. DESIGN: Retrospective review. SETTING: Multiple pediatric trauma centers. PATIENTS: Pediatric patients presenting with tibial shaft fractures treated with intramedullary stabilization. INTERVENTION: Intramedullary stabilization following closed or open reduction (percutaneous and open approach) MAIN OUTCOME MEASURES:: Union rates, infection rate (superficial and deep), unplanned return to the operating room. RESULTS: 166 patients were included in this study. 136 patients presented with closed fractures and 30 patients presented with open tibial shaft fractures. 37/136 patients (27%) with closed fractures had their fracture specifically opened during surgical fixation. There was no statistical difference in radiographic union at 6 months between fractures electively opened versus those treated with closed reduction alone 97% vs. 97% (p=0.9). No patient who underwent an open reduction developed infection or wound healing concerns, while 2/99 (2%) patients treated closed had superficial surgical site infections requiring additional treatment (p = .999). There was no difference in unplanned return to OR between those that underwent open reduction at the time of intramedullary stabilization. (p = .568). CONCLUSION: Performing an open reduction in a closed pediatric tibial shaft fracture prior to intramedullary fixation does not increase the risk of surgical site infection or wound issues, delayed union, or unplanned return to the operating room. An open reduction of a closed tibial shaft fracture for purposes of improving a reduction prior to intramedullary stabilization may be a safe and effective clinical practice. LEVEL OF EVIDENCE: Therapeutic Level III.