Surgery is not always necessary for children and young people with open bone fractures in the forearm or lower leg, new research suggests.
A small study led by investigators at the Johns Hopkins Children´s Center in the US showed that such fractures can heal safely without surgery – challenging the conventional approach that calls for preemptive surgery on every paediatric fracture.
Clean open bone breaks, also known as Type One fractures, tend to heal on their own without infection or complications, the researchers argued. This applies in cases where the wound is small – less half an inch in diameter – and the surrounding tissue is free of visible contamination with dirt or debris.
“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,” explained study senior investigator Paul Sponseller, M.D., M.B.A., director of paediatric orthopaedics at the Johns Hopkins Children´s Center. “We believe our results set the stage for a larger study to settle the long-standing debate on this issue once and for all.”
According to Johns Hopkins Medicine, the traditional surgical approach requires general anaesthesia and the surgical creation of a larger opening around the wound to access the bone. The non-surgical procedure uses local anaesthesia, rather than general. It requires irrigating and cleaning the flesh wound without cutting any further around the break, and then setting the bone ends together and casting the limb.
The researchers concluded that, as well as avoiding the risks associated with general anaesthesia and surgery, the non-surgical approach leads to less scarring and faster recovery.
Their findings have been published in the Journal of Children´s Orthopaedics.