Quality Improvement Case Series Severe Consequences of the Misclassification and Subsequent Undertreatment of 'Type 1' Open Fractures

Abstract

Operative treatment with formal irrigation and debridement has classically been considered the standard of care for open forearm fractures. Considerable debate exists regarding the management of type 1 open forearm fractures in the pediatric population. Several recent studies have demonstrated that nonoperative management consisting of local wound irrigation and debridement in the emergency department, followed by closed reduction and casting with a course of antibiotics may be an appropriate treatment option for these fractures.  The purpose of the current case study is to present two cases of open forearm fractures, which were designated as type 1 fractures, in young children that resulted in devastating outcomes following emergency department wound management and fracture care.