Key Insights On Managing Pediatric Fractures With Ex-Fix

Ron Raducanu DPM FACFAS

In my blog last month, I began a discussion on the use of external fixation in podopediatric surgery (see ). Probably the least complex use of external fixation in the pediatric population is for fracture management.
External fixation is not as effective with Salter Harris type growth plate injuries as there are particular considerations with these injuries. However, external fixation can be effective in the active teenage population, particularly when it comes to fresh metatarsal fractures. The ideal situation is one in which the fracture is transverse, extra-articular, and there is minimal shift in alignment and length. However, one can also use an ex-fix device to return a compression fracture to its proper length intra-operatively.
One other consideration is whether the fracture is of the Greenstick variety. Sometimes these do not require any type of intervention but ex-fix can serve to stabilize and compress these fractures if necessary.
Why do I like ex-fix in pediatric fractures? The first reason is the minimally invasive nature of the procedure in the right hands. When there is a long bone fracture, two to four small stab incisions are all that are required to fixate these fractures under the direction of a mini C-arm. For kids, this can eliminate an unsightly scar.
I also prefer this method as there is no retained hardware. Most of the time, you will remove the external fixation once the fracture has healed, or shortly thereafter.

What You Should Know About Post-Op Issues And Antibiotic Considerations 

When using ex-fix in kids, it is important to have a firm grasp of the immediate postoperative course and its potential pitfalls. When dealing with any type of external fixation, probably the biggest postoperative worry is a pin tract infection. This is bound to happen and surgeons must be acutely aware of the signs and symptoms as well as the best treatment modality for each particular age category.
Most of the time, the surgeon needs to handle pin tract infection issues at the skin and dressing level. You also need to have an idea if the patient’s family is up to the task of caring for the potential consequences of using ex-fix.
Furthermore, in the pediatric population, it is important to know which antibiotics to use and which not to use. For instance, with open growth plates, levofloxacin (Levaquin, Ortho-McNeil) is absolutely contraindicated. Although it would be an excellent choice for that diabetic Charcot reconstruction, using this antibiotic in the pediatric population is a great danger for which you can be held liable. 
My next blog will discuss the elective uses of external fixation.

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