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Submuscular Bridge Plating for Complex Pediatric Femur Fractures Is Reliable

  • Symposium: Tscherne Festschrift
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Complex, high-energy pediatric femur diaphyseal fractures cannot be treated reliably by conventional methods: casting is not suitable for polytrauma and large children, external fixation is associated with a high rate of malalignment and refractures, elastic nails are unsuitable for unstable fractures and metaphyseal areas, and lateral trochanteric entry rigid nails cannot address proximal and distal fragments and need relatively large medullary canals. A few centers have reported that submuscular bridge plating (SBP) is associated with minimal complications, but these findings require confirmation.

Questions/purposes

We asked whether SBP (1) reproducibly leads to union in unstable fractures with a low complication rate, (2) leads to reasonable alignment and leg length equality (3), is unaffected by age, weight, or location of fracture, and (4) is associated with no or minimal refracture after hardware removal.

Methods

We retrospectively reviewed 60 fractures in 58 patients with pediatric diaphyseal femoral fractures treated with SBP from 1999 to 2011. The average age was 9 years. Forty (67%) of the fractures were unstable. Minimum followup was 2.4 months (average, 15.5 months; range, 2.4–50.6 months).

Results

All fractures healed well and all patients returned to full activity. Two of the 58 patients (3%) had major complications leading to unplanned surgeries: one implant failure and one deep infection in an old open fracture. None of the patients developed clinically important malalignment or leg length discrepancy. Implant removal was performed in 49 patients without complications.

Conclusions

SBP provided reliable fixation and healing for complex pediatric femur fractures and can have a broader application in the orthopaedic community. SBP is our preferred method for unstable fractures or fractures of the proximal and distal shaft.

Level of Evidence

Level IV, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.

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Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery & Rehabilitation, Texas Tech University Health Sciences Center, 4800 Alberta Avenue, El Paso, TX, 79905-2700, USA

    Amr A. Abdelgawad MD, Ryan N. Sieg MD, Matthew D. Laughlin DO, Juan Shunia MD & Enes M. Kanlic MD

  2. Department of Orthopaedic Surgery & Rehabilitation, William Beaumont Army Medical Center, El Paso, TX, USA

    Ryan N. Sieg MD & Matthew D. Laughlin DO

Authors
  1. Amr A. Abdelgawad MD
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  2. Ryan N. Sieg MD
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  3. Matthew D. Laughlin DO
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  4. Juan Shunia MD
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  5. Enes M. Kanlic MD
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Corresponding author

Correspondence to Amr A. Abdelgawad MD.

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Each author certifies that he or she, or a member of his or her immediate family, has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that the institutions in which the study was performed (University Medical Center of El Paso and Texas Tech University Health Sciences Center) approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

This work was performed at University Medical Center of El Paso (El Paso, TX, USA) and Texas Tech University Health Sciences Center (El Paso, TX, USA).

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Abdelgawad, A.A., Sieg, R.N., Laughlin, M.D. et al. Submuscular Bridge Plating for Complex Pediatric Femur Fractures Is Reliable. Clin Orthop Relat Res 471, 2797–2807 (2013). https://doi.org/10.1007/s11999-013-2931-9

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