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Implant removal after submuscular plating for pediatric femur fractures
Olivia Pate1, Daniel Hedequist, Natalie Leong
1Department of Orthopedics, Childrens Hospital, Harvard Medical School, Boston, MA 02481, USA.
Insights
Plate removal after pediatric femur fracture surgery can be complicated by bone overgrowth, requiring more extensive procedures. This overgrowth, not the timing of removal, is the key factor for potential difficulties during plate removal.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Biomedical engineering
Background:
- Submuscular plating is increasingly used for pediatric femur fractures, especially length-unstable ones.
- This technique uses internal fixators with minimally invasive insertion and long plates for stable fixation and fracture biology preservation.
- Plate removal after submuscular plating in children has not been previously documented.
Purpose of the Study:
- To investigate complications and challenges associated with submuscular plate removal in pediatric femur fractures.
- To identify factors influencing the difficulty of plate removal after submuscular plating.
Main Methods:
- A retrospective review of 22 pediatric patients who underwent submuscular plate removal for femur fractures.
- Analysis of radiographs and patient charts to assess removal complications and identify contributing factors.
- Level of evidence: Case series, level 4.
Main Results:
- Seven out of 22 patients required a more extensive surgical procedure for plate removal than for insertion.
- The primary reason for increased operative difficulty was bony overgrowth at the leading edge of the plate.
- Radiographic evidence of this overgrowth was observed early in the healing process for patients requiring more extensive removal procedures.
Conclusions:
- The timing of submuscular plate removal does not significantly impact the potential for complications.
- Bony overgrowth at the leading plate edge is the critical factor determining difficulties during removal.
- Patients experiencing leading plate edge overgrowth should be informed about the potential need for increased operative exposure during plate removal.
Background:
Submuscular plating for pediatric femur fracture has become more commonplace for treatment of length unstable fractures. These plates act as an internal fixator and rely on minimally invasive insertion techniques and long plate lengths to achieve the goal of stable fixation and local biologic fracture preservation. Plate removal in children after submuscular plating has not been reported in the literature.
Methods:
We reviewed the records of 22 patients at our institution who were treated with a submuscular plate, which was eventually removed after fracture healing. A review of the radiographs and charts was performed to determine any unique problems or complications that may arise during the removal of these plates given their long lengths and minimally invasive insertion.
Results:
In our series, 7 patients required a more extensive procedure to remove the plate than was required during plate insertion. These patients all required an open procedure at the leading edge of the plate to chisel overgrown bone away from the plate for removal. The timing of removal in our series was not related to difficulties during plate removal, rather it was the presence of bony overgrowth at the plates leading edge. This overgrowth was seen early on radiographically during the healing process in all patients who required increased operative exposure.
Conclusions:
The timing of plate removal after submuscular plating is not critical when trying to determine the potential complications at plate removal. The decisive factor related to difficulties with plate removal is leading plate edge overgrowth. Patients with this bone overgrowth at the leading edge of the plate need to be counseled regarding the need for an increased operative exposure during plate removal.
Level Of Evidence:
Case series, level 4.
