Evaluation of Pediatric Lower Extremity Fractures Managed With External Fixation: Outcomes in a Deployed Environment

External fixation of pediatric lower extremity fractures is usually reserved for severe, open fractures in poly­traumatized patients, but it is often the only available treatment option for deployed military surgeons. We analyzed the outcomes and complications of 17 consec­utive pediatric long bone fractures treated with external fixation at a Forward Surgical Team facility in an austere environment during Operation Enduring Freedom in Afghanistan during a 12-month period.

Treatment consisted of uniplanar external fixation for 12 femoral shaft fractures (11 closed), 4 tibial shaft frac­tures (all open), and 1 subtrochanteric fracture (closed) in 14 males and 3 females with an average age of 7.4 years. All 17 fractures went on to union with no inci­dences of refracture. Complications included 1 broken pin and 3 pin site infections treated with wound care and oral antibiotics.

In a deployed environment, external fixation is the treat­ment method of choice for lower extremity fractures by virtue of patient, environment, equipment, and mission factors. This case series validates the usage of a simple, uniplanar external fixator for a variety of open and closed pediatric long bone fractures as evidenced by the suc­cessful union rate and low number of complications.