Submuscular Bridge Plating for Complex Pediatric Femur Fractures Is Reliable

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.

How Long Do We Need to Restrict Weight Bearing after Fixation of Pediatric Femur Fractures?

“…Time to full weight bearing has been used as another outcome measure, reported at an average of 8 weeks for compression plating, 7 weeks for submuscular plating, and 12 weeks for flexible nailing [4,12]. However, postoperative weight bearing protocols vary widely between providers and institutions, with some allowing immediate weight bearing with assistive device, others requiring touchdown weight bearing until callus formation, with progressive advancement, and others still preferring non-weight bearing until callus formation [5,[7][8][9][10][11]15].…”

“…Though several studies demonstrate consistency in healing time and clinical outcomes between these different fixation methods, postoperative weight bearing protocols vary widely between providers, with some requiring non-weight bearing until evidence of radiographic healing, others allowing touchdown weight bearing for 6 weeks with progressive advancement thereafter, and some even further immobilizing in spica casts [4][5][6][7][8][9][10][11][12]. Periods of weight bearing protected by assistive device also vary depending on surgeon preferences [13].…”

Untere Extremität: die kindliche Schaftfraktur

“…Auch der Fixateur externe ist immer noch eine denkbare Alternative, allerdings wird die Plattenosteosynthese in neueren Arbeiten auch wieder Gegenstand der Diskussion [1,3,5]. Neuere Studien zeigen, dass am Femur der Einsatz von speziellen Verriegelungsnägeln für Adoleszente ebenfalls ein gutes Verfahren darstellt [12], für den Unterschenkel sollte hier der Verschluss der kniegelenknahen Wachstumsfuge abgewartet werden.…”

Developments in the Treatment of Pediatric Long Bone Shaft Fractures

“…29 However, rigid nails have shown to decrease rotational instability, which has also recently been described for a locked submuscular bridge plating technique representing another treatment option in adolescent patients. 46,47 Rotational malunion and leg length discrepancy of the femur are also major concerns after overhead extension in young children, which may exceed ability to repair and to remodel with growth. For this reason, and also because of the socioeconomic aspect of shortening the length of hospital stay, the ESIN technique is increasingly expanded within the cohort of patients younger than 3 years.…”