When most laypeople—and perhaps some orthopaedists—see a child with a fractured arm or leg bone poking through a skin wound, they probably think surgery is inevitable. But a recent study in the Journal of Children’s Orthopaedics, co-authored by JBJS Deputy Editor for Pediatrics Paul Sponseller, MD, found that among 40 pediatric patients with nonoperatively treated type I open fractures (where the bone communicates with a clean wound less than 1 cm in length), there were no infections, and all patients eventually had complete bony union. The nonoperative treatment included irrigation and debridement followed by closed reduction and casting, and all patients were discharged home from the ED. The only complication was a small retained foreign body walled off by a non-infected granuloma that was removed uneventfully in the clinic four weeks after the initial procedure.
In a news release, Dr. Sponseller said, “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 treatments.” The limited number of patients in the study did not power it sufficiently to draw ironclad conclusions, and the authors concluded that “additional prospective randomized clinical trials are needed to make a definitive level I recommendation regarding nonoperative management.”