The Treatment of Type I Open Fractures in Pediatrics

NCT ID: NCT00870064

Last Updated: 2025-06-29

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

300 participants

Study Classification

INTERVENTIONAL

Study Start Date

2010-03-31

Study Completion Date

2026-06-30

Brief Summary

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Open fractures are frequently encountered in orthopaedics. Treatment usually calls for a formal, operative procedure in which the bone is exposed, foreign tissue is debrided and the wound is irrigated. While this is the current standard of care, not all open fractures are equal. In retrospective studies, centers are reporting less aggressive operative management for open fractures may result in equal results without the time and expense of the operative theater. The investigators propose a prospective, randomized trial of children with type I open fractures to evaluate whether formal operative treatment is necessary. The investigators' hypothesis is that minor open fractures can be safely treated in the emergency room with irrigation, closed reduction and home antibiotics without an increased risk of infection or other complications. Children who meet the study criteria will be randomized into two treatment arms - formal operative management (OR) and emergency department (ED) management. Outcomes from each group will be evaluated and compared, including rate of infection, number of return visits to the operating room, time to union, and other complications.

Detailed Description

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Fractures in which bone has been exposed to the outside world through an associated skin injury, known as open fractures, are frequently encountered in orthopaedics. Traditionally, treatment calls for a formal, operative treatment in which the bone is exposed, foreign tissue is debrided and the wound is irrigated. The bone itself, depending on the age of the patient, fracture location and stability is then treated by the appropriate method of casting or internal fixation. However, while this is the current standard of care for all open fractures, not all open fractures are the same and can differ in terms of the bone involved, energy causing the injury and the skeletal maturity of the patient. Children, for example, have a thick periosteum which may diminish the rate of infection and decrease the time to healing. In addition, the protocol of operative debridement was introduced at the same time as widespread antibiotic use. It is not known whether the mechanical operative management or antibiotic use has resulted in improved outcomes. In retrospective studies, centers are reporting emergency department management alone may result in equal results without the time and expense of the operative theater.

The investigators propose a prospective, randomized trial of children with type I open fractures to evaluate whether formal operative treatment is necessary. The investigators hypothesize that minor open fractures in children can be safely treated in the emergency room with irrigation, closed reduction and home antibiotics without an increased risk of infection or other complications. If the inclusion criteria is met and informed consent is obtained, children will be randomized into two treatment arms - formal operative management (OR) and emergency department (ED) management. Children randomized to the OR arm will be taken to the OR within 24 hours for irrigation and debridement and appropriate bone management. Children in the ED arm will have a washout in the emergency room under conscious sedation, a closed reduction and home antibiotics. Both wounds will be examined at interval follow up periods for signs of infection. Outcomes evaluated will include the rate of infection, the number of return visits to the operating room, the time to bone healing, and other complications. This is a pilot study with the plan of eventually being a multicenter study evaluating open fracture care in children.

Conditions

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Fractures, Open

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Formal Operative Treatment

Children randomized to the formal operative management arm will be taken to the Operating Room within 24 hours for irrigation and debridement and appropriate bone management.

Group Type OTHER

Formal Operative Treatment

Intervention Type PROCEDURE

Children randomized to the OR arm will be taken to the OR within 24 hours for irrigation and debridement and appropriate bone management.

Emergency Department Treatment

Children in the Emergency Department Treatment arm will have a washout in the emergency room under conscious sedation, a closed reduction and home antibiotics.

Group Type OTHER

Emergency Department Treatment

Intervention Type PROCEDURE

Children in the ED arm will have a washout in the emergency room under conscious sedation, a closed reduction and home antibiotics.

Interventions

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Formal Operative Treatment

Children randomized to the OR arm will be taken to the OR within 24 hours for irrigation and debridement and appropriate bone management.

Intervention Type PROCEDURE

Emergency Department Treatment

Children in the ED arm will have a washout in the emergency room under conscious sedation, a closed reduction and home antibiotics.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* open fracture amenable to treatment by closed reduction
* low energy mechanism of injury (e.g., falls from less than 10 feet, bicycle accidents)
* wound less than 1cm in length and the bone not visualized through the skin

Exclusion Criteria

* open fracture not amenable to treatment by closed reduction
* open fracture that would typically require operative reduction and fixation
* high energy mechanism of injury (e.g., struck by vehicle, motor vehicle accidents, fall from height greater than 10 feet)
* wound greater than 1cm in length
* gross contamination of wound
* open fractures involving hands or feet (the current standard of care to treat open injuries involving hands or feet is only emergency room management)
Minimum Eligible Age

3 Years

Maximum Eligible Age

14 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Provincial Health Services Authority

OTHER

Sponsor Role collaborator

University of Mississippi Medical Center

OTHER

Sponsor Role collaborator

MultiCare Mary Bridge Children's Hospital & Health Center

OTHER

Sponsor Role collaborator

Yale New Haven Health System Center for Healthcare Solutions

OTHER

Sponsor Role collaborator

University of New Mexico Carrie Tingley Hospital

UNKNOWN

Sponsor Role collaborator

IWK Health Centre

OTHER

Sponsor Role collaborator

Phoenix Children's Hospital

OTHER

Sponsor Role collaborator

Children's Hospital Colorado

OTHER

Sponsor Role collaborator

Nationwide Children's Hospital

OTHER

Sponsor Role collaborator

Morristown Medical Center

OTHER

Sponsor Role collaborator

NYUMC-Hospital for Joint Diseases

UNKNOWN

Sponsor Role collaborator

Children's Medical Center Dallas

OTHER

Sponsor Role collaborator

Johns Hopkins University

OTHER

Sponsor Role collaborator

Orthopaedic Institute for Children

OTHER

Sponsor Role collaborator

Children's Hospital Los Angeles

OTHER

Sponsor Role collaborator

St. Christopher's Hospital for Children

OTHER

Sponsor Role collaborator

Children's Hospital of Orange County

OTHER

Sponsor Role collaborator

Ann & Robert H Lurie Children's Hospital of Chicago

OTHER

Sponsor Role lead

Responsible Party

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Joseph Janicki

MD, Assistant Professor of Pediatrics, Northwestern University Feinberg School of Medicine

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Joseph (Jay) A Janicki, MD, MS

Role: PRINCIPAL_INVESTIGATOR

Ann & Robert H Lurie Children's Hospital of Chicago

Locations

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Ann & Robert H. Lurie Children's Hospital of Chicago

Chicago, Illinois, United States

Site Status RECRUITING

Countries

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United States

Central Contacts

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Jamie K Burgess, PhD, CCRP

Role: CONTACT

312-227-6531

Candace C Young, BS

Role: CONTACT

312-227-6427

Facility Contacts

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Joseph (Jay) A Janicki, MD, MS

Role: primary

312-227-6194

Carly A Strohbach, BA

Role: backup

312-227-6627

References

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Yang EC, Eisler J. Treatment of isolated type I open fractures: is emergent operative debridement necessary? Clin Orthop Relat Res. 2003 May;(410):289-94. doi: 10.1097/01.blo.0000063795.32430.4c.

Reference Type BACKGROUND
PMID: 12771843 (View on PubMed)

Iobst CA, Tidwell MA, King WF. Nonoperative management of pediatric type I open fractures. J Pediatr Orthop. 2005 Jul-Aug;25(4):513-7. doi: 10.1097/01.bpo.0000158779.45226.74.

Reference Type BACKGROUND
PMID: 15958906 (View on PubMed)

Doak J, Ferrick M. Nonoperative management of pediatric grade 1 open fractures with less than a 24-hour admission. J Pediatr Orthop. 2009 Jan-Feb;29(1):49-51. doi: 10.1097/BPO.0b013e3181901c66.

Reference Type BACKGROUND
PMID: 19098646 (View on PubMed)

Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am. 1976 Jun;58(4):453-8.

Reference Type BACKGROUND
PMID: 773941 (View on PubMed)

Grimard G, Naudie D, Laberge LC, Hamdy RC. Open fractures of the tibia in children. Clin Orthop Relat Res. 1996 Nov;(332):62-70. doi: 10.1097/00003086-199611000-00009.

Reference Type BACKGROUND
PMID: 8913146 (View on PubMed)

Haasbeek JF, Cole WG. Open fractures of the arm in children. J Bone Joint Surg Br. 1995 Jul;77(4):576-81.

Reference Type BACKGROUND
PMID: 7615601 (View on PubMed)

Skaggs DL, Kautz SM, Kay RM, Tolo VT. Effect of delay of surgical treatment on rate of infection in open fractures in children. J Pediatr Orthop. 2000 Jan-Feb;20(1):19-22.

Reference Type BACKGROUND
PMID: 10641682 (View on PubMed)

Jones BG, Duncan RD. Open tibial fractures in children under 13 years of age--10 years experience. Injury. 2003 Oct;34(10):776-80. doi: 10.1016/s0020-1383(03)00031-7.

Reference Type BACKGROUND
PMID: 14519359 (View on PubMed)

Jones IE, Williams SM, Dow N, Goulding A. How many children remain fracture-free during growth? a longitudinal study of children and adolescents participating in the Dunedin Multidisciplinary Health and Development Study. Osteoporos Int. 2002 Dec;13(12):990-5. doi: 10.1007/s001980200137.

Reference Type BACKGROUND
PMID: 12459942 (View on PubMed)

Related Links

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https://www.cdc.gov/infection-control/hcp/surgical-site-infection/index.html

Center for Disease Control. (12 April 2024). Surgical Site Infection. In Center for Disease Control and Prevention. Retrieved August 28, 2024

Other Identifiers

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2012-13763

Identifier Type: -

Identifier Source: org_study_id

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