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Orthopaedics & Traumatology: Surgery & Research
Sous presse. Epreuves corrigées par l'auteur. Disponible en ligne depuis le samedi 8 avril 2017
Doi : 10.1016/j.otsr.2017.01.012
Received : 10 September 2016 ;  accepted : 6 January 2017
Bone healing is achievable despite extensive wound dehiscence and wide plate and screws exposure in children
 

E. Melhem , W. Bayoud, I. Ghanem
 Department of Orthopaedic Surgery, Hotel-Dieu de France Hospital, Saint Joseph University, 166830 Beirut, Lebanon 

Corresponding author.
Abstract
Background

Extensive wound dehiscence and wide plate and screw exposure in the early weeks following orthopaedic surgery in children is usually managed either by extensive debridement, lavage and secondary closure or hardware removal and external fixation.

Patients

Three children with LCP plate and screws exposure were managed by simple repetitive debridement and local wound care without any IV antibiotics, nor secondary closure or hardware removal. All three cases occurred in the tibia, one following tibial osteotomy in lateral hemimelia with a long history of previous surgeries, one following wide excision of a tibial Ewing sarcoma with chemo- and radiotherapy, and the third following wide excision of a 12cm necrotic tibial segment due to chronic osteomyelitis. Bone healing was uneventful in 2 cases and was in progress in the case with the Ewing sarcoma. Plate and screws were removed in all cases, following an obvious bone healing in 2 cases, and forced by the need for chemotherapy due to the presence of lung metastases in the third case. Spontaneous soft tissue healing occurred thereafter.

Conclusion

A stable fixation may lead to a good bone healing despite an extensive wound dehiscence and a wide plate and screws exposure with just a proper local wound care and without any major additional surgery.

Level of evidence

Level IV.

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Keywords : Plate exposition, Dehiscence, Infection, Osteosynthesis




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