Clinical Orthopaedics and Related Research®

, Volume 471, Issue 9, pp 2797–2807

Submuscular Bridge Plating for Complex Pediatric Femur Fractures Is Reliable

Authors

    • Department of Orthopaedic Surgery & RehabilitationTexas Tech University Health Sciences Center
  • Ryan N. Sieg
    • Department of Orthopaedic Surgery & RehabilitationTexas Tech University Health Sciences Center
    • Department of Orthopaedic Surgery & RehabilitationWilliam Beaumont Army Medical Center
  • Matthew D. Laughlin
    • Department of Orthopaedic Surgery & RehabilitationTexas Tech University Health Sciences Center
    • Department of Orthopaedic Surgery & RehabilitationWilliam Beaumont Army Medical Center
  • Juan Shunia
    • Department of Orthopaedic Surgery & RehabilitationTexas Tech University Health Sciences Center
  • Enes M. Kanlic
    • Department of Orthopaedic Surgery & RehabilitationTexas Tech University Health Sciences Center
Symposium: Tscherne Festschrift

DOI: 10.1007/s11999-013-2931-9

Cite this article as:
Abdelgawad, A.A., Sieg, R.N., Laughlin, M.D. et al. Clin Orthop Relat Res (2013) 471: 2797. doi:10.1007/s11999-013-2931-9

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.

Copyright information

© The Association of Bone and Joint Surgeons® 2013