Open tibial shaft fracture in 6 Y/M with autism spectrum dis
A 6-year-old boy with ASD was hit by a truck at a speed of about 20 km/h and was brought to the emergency department. After emergency transportation, the patient was anxious and could not stay calm, so sedation was deemed necessary. The patient complained of pain in the right lower leg and an open wound about 5 mm in length was apparent on the inside of the right lower leg over the tibia. Radiography and computed tomography (CT) showed fractures of the right tibia and fibula, and open fracture of the right tibial shaft was diagnosed (Orthopaedic Trauma Association classification 42A1, 4F2A).

Researchers performed surgery for osteosynthesis and debridement the same day. After irrigating and disinfecting the open wound, closed reduction was performed and good alignment was obtained. The tibia was temporarily fixed using a 2.0-mm Kirschner wire, then osteosynthesis was performed using a ring external fixator.

Surgeons used two rings, fixing each ring with three wires. Gustilo classification type I was diagnosed and primary closure of the open wound was performed after irrigation. Intravenous antibiotics were continued until postoperative day (POD)2.

The patient was allowed full weight-bearing from POD1. As of 3 weeks after surgery, the patient was performing full weight-bearing with no problems in daily activities. Pin-site infection was observed during outpatient follow-up, but was successfully treated with oral antibiotics. As of POD84, the external fixator was removed. At 6 months postoperatively, the patient showed no problems in activities of daily living, no abnormal alignment of the lower leg, and no leg-length discrepancy.

For pediatric, low-grade open fractures such as Gustilo classification type I, primary closure of the open wound after sufficient bone fixation is safe.