Classification system for pediatric open fractures: A modification of the Gustilo-Anderson system for pediatric size

Background: There is no universal classification of open fractures specific to children. Orthopaedic surgeons use the Gustilo-Anderson classification for both adults and children despite the unique characteristics of the pediatric skeleton. Major differences include smaller extremities, greater healing potential, and better periosteal bone formation. The classification of open fractures involves an element of subjective judgment, especially regarding intermediate types of injury such as type II. This becomes crucial when prompt administration of appropriate antibiotics is clearly an important way to minimize risk for infection associated with open fractures. Methods: We measured four limb segments in 100 adult volunteers to determine the average size of each limb segment and compared this to the current open fracture classification wound sizes to formulate a universal size percentage that can be easily applied to the pediatric population. Results: We found that 30% of the overall limb segment in a pediatric patient (average of length and circumference) is equivalent to a 10cm wound in the adult population. Conclusions: Using this simple comparison, we can modify the Gustilo-Anderson classification to provide a more specific guide in the management of open fractures among children, in particular the clarification of type II and type III wounds. Clinical Relevance: These data may be used to study the effects of a modified open fracture classification for children and to further define the effects on improving infection rates in this patient population.