Pediatric Extra-Articular Proximal Femoral Fracture Fixation With a Submuscular Non-Locking Plate

Area of Science:

• Orthopedic surgery
• Pediatric orthopedics
• Fracture management

Background:

• Extra-articular proximal femoral fractures (EPFF) in children present unique challenges due to strong muscular forces.
• Submuscular plating with a non-locking plate is a viable treatment option for children aged 6 to 14 years.

Purpose of the Study:

• To describe the surgical technique for submuscular plating of pediatric EPFF.
• To evaluate the efficacy and outcomes of this minimally invasive approach.

Main Methods:

• The procedure involves general anesthesia, a fracture table, and a stainless steel non-locking dynamic compression plate (DCP).
• A submuscular tunnel is created for plate placement on the lateral aspect of the femur, secured with non-locking screws.
• Postoperative management includes non-weight-bearing status until radiographic signs of healing, followed by progressive weight-bearing and range-of-motion exercises.

Main Results:

• In a study of 15 patients, all fractures healed uneventfully with a mean union time of 11.8 weeks.
• No patients required subsequent surgery for complications or malunion.
• Thirteen patients achieved excellent outcomes based on the Flynn criteria.

Conclusions:

• Submuscular plating is a safe and effective method for treating pediatric EPFF, offering stable fixation and facilitating fracture union.
• The minimally invasive approach preserves the fracture hematoma, promoting biological fixation.
• Adherence to surgical technique, including appropriate plate selection and positioning, is crucial for optimal results.