Session IX - Pediatrics

Bridge Plating of Pediatric Femur Fractures

Enes M. Kanlic, MD, PhD¹; Douglas G. Smith, MD²; Jeffrey O. Anglen, MD³; Steven B. Morgan, MD⁴; Rodrigo R. Pesantez, MD⁵; ¹Texas Tech University, El Paso, Texas, USA; ²Harborview Medical Center, University of Washington, Seattle, Washington, USA; ³University of Missouri Hospitals and Clinics, Columbia, Missouri, USA; ⁴Denver Health Medical Center, Denver, Colorado, USA;⁵Fundación Santa Fe' de Bogota, Bogota, Columbia

Introduction: A minimally invasive plating technique to provide "elastic" fixation for all types of pediatric femoral shaft fractures may help to overcome the limitations and complications of conventional treatment methods. We provide a comparison of our results with those of conventional methods.

Methods: Forty-nine patients with an average age of 10.3 years were included in a retrospective nonrandomized multicenter clinical study. Twenty-one had sustained multiple trauma; 51% of the fractures were unstable, and 3 were open. Twenty-four percent of the fractures were localized in the subtrochanteric (12) and distal third (2) femur area. With this technique, fractures were reduced under x-ray control. A long plate was introduced through small incisions beneath the muscle and superficial to the periosteum. The zone of injury was not exposed. Screws were placed in each main fragment percutaneously, leaving the central screw holes empty. The elastic construct allowed painless rapid mobilization and enhanced bone healing without the need for additional bracing or casting.

Results: Fifteen surgeons had an average procedure time of 117 minutes and x-ray time of 78 seconds. No infections or nonunions occurred. All patients had excellent clinical results. Complications consisted of one temporary peroneal nerve palsy and two revisions for technical failures: one as a result of early hardware breakage (3.5-mm titanium plate) and one re-fracture after premature plate removal.

Discussion and Conclusion: Other methods have had reports of up to 10% significant complications. They cannot be used to treat all unstable fractures, and, often, additional external protection is required. Bridge plating provides elastic fixation for all types of fractures without the need for bracing and casting, with excellent and reproducible results.