Management of fractures in children with thermal injuries

The purpose of this study is to analyze how fractures are managed in children with associated acute bums. A retrospective review of 20 years of experience at a major U.S. bum center was undertaken. A total of 28 fractures in 18 patients were identified during this time period. Variables studied included mechanism of the burn, fracture location, associated injuries, and type of fracture. The fractures were then analyzed according to management, healing times, and complication rates. Of the 24 available fractures, 22 went on to union in an appropriate amount of time. The average rate to union was 9.9 weeks and average follow-up was 32.5 months. There were five infectious complications, one loss of reduction, one knee instability, and one malunion requiring additional surgery. This study supports early definitive fracture treatment in the burned child. If internal fixation is chosen, it can be safely performed if performed within the first 48 hours after the burn. External fixation is also a viable alternative. High rates of union are possible.