Session VIII - Pediatrics
Sat, 10/9/04 Pediatrics, Paper #45, 3:19 pm
Plate Fixation of Pediatric Femur Fractures
Purpose: Despite advances in care and a trend toward surgical stabilization and mobilization, the appropriate operative treatment of isolated femur fractures is still debatable. It is our belief that plating is a safe and effective means of operative stabilization in isolated injuries as well as for polytrauma patients. We believe that the complications and effects on leg-length discrepancy of plating are minimal. The purpose of our study was to evaluate and report our results and complications of pediatric femur fractures treated with plate fixation.
Methods: After obtaining Institutional Review Board approval, a CPT code-directed search of our patient database was performed for children ages 16 and under who underwent open reduction and internal fixation (ORIF) of femoral shaft fractures with use of plates and screws from January 1996 to December 2002. Patients with closed physes, intraarticular fractures, or fractures with physeal involvement were excluded. We identified 116 children who met these criteria, and all of their clinic and hospital charts and radiographs were reviewed. Information gathered from these records included age, sex, mechanism of injury, polytrauma or isolated fracture, associated injuries, fracture type, fracture location, date of admission and discharge, date of surgery, operating surgeon, and implants utilized. In addition to standard demographic data, any complications were identified. Nonunion, malunion, infection, and leg-length discrepancy were assessed. Hospital stay, time to full weight-bearing, and time to radiographic healing were calculated from a review of radiographs and follow-up clinical examinations. Leg-length discrepancy was calculated from standing-alignment radiographs obtained at follow-up.
Patients were surgically stabilized as soon as possible after admission; all fractures were stabilized with plates and screws. Patients were maintained non-weight-bearing until healing was identified, as evidenced by callus formation on radiographs. Patients were then allowed partial weight-bearing until radiographic union was established. No supplemental postoperative immobilization was used. Implant removal was recommended at 4 to 6 months postoperatively.
Results: There were 116 patients, ranging in age from 2.9 to 16.5 years (average, 9), with 124 fractures. The predominant mechanisms of injury were motor vehicle accident, 38; pedestrian versus motor vehicle, 33; and car versus bicycle, 15. Sixty-one were isolated injuries and 63 were classified as polytrauma. Three fractures (2.4%) were open. The average length of hospital stay was 9 days for all patients (range, 1 to 141), 3 days for isolated fractures, and 15 days for polytrauma patients. Time until radiographic healing was an average of 72 days, and time to full weight-bearing averaged 57 days. The average leg-length difference was 0.22 cm of overgrowth (range, 0.5 to 2.4). Only one patient had more than 1 cm of overgrowth. There were no cases of deep infection, malunion, or nonunion. One plate bent, one plate broke, and one patient sustained a fracture below the plate after a fall. Implant removal could be documented in 100 patients; the average time to removal was 206 days (range, 92 to 549).
Conclusion/Significance: Plate fixation provides rigid fixation, allows for rapid mobilization, and facilitates nursing care. It is a familiar, safe, and effective technique for managing femur fractures in children who are skeletally immature, and despite anatomic reduction, leg-length discrepancy is not a concern.