Treatment of Pediatric Diaphyseal Femur Fractures with Plate Fixation

Abstract

The use of submuscular plates for pediatric femur fractures has become more common in the last 10 years. While multiple surgical options exist for this injury in children older than age 5, titanium elastic nailing for fractures has gained the most widespread use, due to ease of insertion, rapid healing, and satisfactory outcomes. However, the use of elastic nailing for length-unstable fractures (oblique or comminuted fractures) has been shown to be associated with unacceptable complications such as shortening, malangulation, and nail migration. Rigid intramedullary nailing through a lateral trochanteric entry point was developed because elastic nails were suboptimal for length-unstable fractures. Excellent clinical results have been obtained with these more rigid implants. However, the frequency and clinical sequelae of potential complications following entry into the proximal femur have not been fully elucidated to date and may include proximal femoral growth arrest and avascular necrosis. Submuscular plating for pediatric femur fractures evolved in order to overcome the stability problems with flexible nails in length-unstable fracture patterns while also avoiding the need to perform reaming of the greater trochanter with rigid intramedullary implants. Open compression plating, while occasionally still needed, has largely been supplanted by the more minimally invasive submuscular bridge plating technique. The use of rigid intramedullary implants will be discussed elsewhere in this book; this chapter focuses on submuscular plating for pediatric femur fractures, with a shorter discussion on open femoral plating.