title: Implant removal after submuscular plating for pediatric femur fractures.
abstract: BACKGROUND
  Submuscular plating for pediatric femur fracture has become more commonplace for treatment of length unstable fractures. These plates act as an internal fixator and rely on minimally invasive insertion techniques and long plate lengths to achieve the goal of stable fixation and local biologic fracture preservation. Plate removal in children after submuscular plating has not been reported in the literature.
  
  
  METHODS
  We reviewed the records of 22 patients at our institution who were treated with a submuscular plate, which was eventually removed after fracture healing. A review of the radiographs and charts was performed to determine any unique problems or complications that may arise during the removal of these plates given their long lengths and minimally invasive insertion.
  
  
  RESULTS
  In our series, 7 patients required a more extensive procedure to remove the plate than was required during plate insertion. These patients all required an open procedure at the leading edge of the plate to chisel overgrown bone away from the plate for removal. The timing of removal in our series was not related to difficulties during plate removal, rather it was the presence of bony overgrowth at the plates leading edge. This overgrowth was seen early on radiographically during the healing process in all patients who required increased operative exposure.
  
  
  CONCLUSIONS
  The timing of plate removal after submuscular plating is not critical when trying to determine the potential complications at plate removal. The decisive factor related to difficulties with plate removal is leading plate edge overgrowth. Patients with this bone overgrowth at the leading edge of the plate need to be counseled regarding the need for an increased operative exposure during plate removal.
  
  
  METHODS
  Case series, level 4.
authors.affiliation: Department of Orthopedics, Childrens Hospital, Harvard Medical School, Boston, MA 02481, USA.
authors.forename: Olivia
authors.initials: O
authors.lastname: Pate
authors.forename: Daniel
authors.initials: D
authors.lastname: Hedequist
authors.forename: Natalie
authors.initials: N
authors.lastname: Leong
authors.forename: Timothy
authors.initials: T
authors.lastname: Hresko
mesh_terms: D000293:Adolescent; D001860:Bone Plates; D002648:Child; D002675:Child, Preschool; D020878:Device Removal / Q000379:methods*; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000295:instrumentation*; D017102:Fracture Healing; D006801:Humans; D016268:Internal Fixators; D008297:Male; D011183:Postoperative Complications; D011859:Radiography; D016896:Treatment Outcome