Paediatric type I open tibia fractures: are antibiotics alone sufficient?

Aims: The conventional management of the soft-tissue component of an open fracture involves emergent debridement. There is, however, evidence that questions this approach in the management of Gustilo-Anderson type I open fractures in paediatric patients. This systematic review aims to explore differences in infection rates between nonoperative management with antibiotics and operative debridement in children with type I open lower limb tibial fractures that do not require surgical fixation. Methods: A systematic review following the PRISMA guidelines was conducted. Patients aged under 18 years with Gustilo-Anderson type I open tibia fractures treated with either antibiotics alone or operative debridement were included. Polytrauma patients and those requiring operative fracture stabilization were excluded. Study bias was assessed with the ROBINS-I (Risk of Bias in Non-randomized Studies of Interventions) tool. Results: Ten retrospective studies of 123 patients with Gustilo-Anderson type I open tibial fractures were included. Nonoperative management in the emergency department with antibiotics was used in 41 patients, with two infections reported (4.87%). Operative debridement was performed in 82 patients, with two infections reported (2.33%). Conclusion: The optimum management for paediatric Gustilo-Anderson type I open tibia fractures remains unclear. There may be selected cases, with true low-energy injury without operative fixation requirements, which can be managed in the emergency department. However, there is not sufficient high-quality evidence to advocate for regular deviation from current guidelines in open tibia fractures in paediatric patients. Decision-making must take into account the energy absorbed, as this factor can be misleading within the current classification system.