Submuscular bridge plating for length-unstable, pediatric femur fractures
Walter P Samora1, Michael Guerriero, Leisel Willis
1*Department of Orthopedic Surgery, Nationwide Children's Hospital †Department of Orthopaedics, The Ohio State University, Columbus, OH.
Insights
Submuscular bridge plating effectively treats pediatric femur fractures, simplifying surgery and ensuring excellent healing with few complications. This technique allows for an early return to full weightbearing for young patients.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Traumatology
Background:
- Submuscular bridge plating is a recognized treatment for pediatric femur fractures.
- Length-unstable fractures present unique challenges in pediatric cases.
- A single-institution review was conducted to evaluate a specific technique.
Purpose of the Study:
- To describe a surgical technique for submuscular bridge plating in pediatric femur fractures.
- To review outcomes of length-unstable pediatric femur fractures treated with this method.
Main Methods:
- A retrospective review of hospital records from 2006-2011.
- Inclusion criteria: length-unstable femur fractures treated with submuscular bridge plating.
- Exclusion criteria: incomplete records, inadequate radiographs, or follow-up <6 months. Level IV evidence.
Main Results:
- 32 patients (33 fractures) were analyzed.
- Mean time to full weightbearing was 8.1 weeks; all healed by 12 weeks.
- No intraoperative complications; one case of implant irritation; no infections or significant malalignment.
Conclusions:
- The described surgical technique simplifies implantation and removal.
- Achieved excellent healing rates and low complication rates.
- Facilitated an early return to full weightbearing for pediatric patients.
Background:
Submuscular bridge plating has become an acceptable method of treatment for pediatric femur fractures. The purpose of our study was to describe a technique for submuscular bridge plating and review a series of consecutive, length-unstable, pediatric femur fractures treated at a single institution with this technique.
Methods:
We performed a query of hospital records from January 4, 2006, to May 10, 2011, to identify length-unstable femur fractures treated with submuscular bridge plating by 5 pediatric surgeons. Included were patients treated with submuscular bridge plating for a femur fracture. Excluded were patients with incomplete medical records, inadequate radiographs, or follow-up <6 months duration. Fifty-one patients met diagnostic criteria; 19 patients were excluded due to incomplete medical records and/or radiographs.
Results:
The study cohort included 32 patients with 33 femur fractures. There were 15 left femurs and 18 right femurs, including 1 bilateral fracture patient. Fracture pattern was composed of 13 comminuted, 5 spiral, 9 long oblique, and 6 short oblique. Mechanisms of injury included: fall from height (8), recreation (23), and MVA (2). Mean time for full weightbearing was 8.1 weeks (range, 3 to 17.6 wk). All patients were radiographically healed by their 12-week assessment. There were no intraoperative complications. Implant removal occurred in 26 patients. There were 2 cases of a broken screw discovered upon implant removal. The remnant screw was not removed in either case. The mean follow-up time for those with implant removal was 43.6 weeks (range, 27 to 83 wk). The 11 patients without implant removal had a mean follow-up time of 38.6 weeks (range, 31.6 to 50 wk). There were no cases of varus or valgus malalignment >10 degrees. One patient experienced implant irritation. There were no cases of wound infections.
Conclusions:
Our technique of surgical intervention has simplified both implantation and removal, and produced comparable and excellent healing rates, low complication rates, and early return to full weightbearing.
Level Of Evidence:
Level IV, case series.
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