Implant removal after submuscular plating for pediatric femur fractures.
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.
Pate
Olivia
O
Department of Orthopedics, Childrens Hospital, Harvard Medical School, Boston, MA 02481, USA.
Hedequist
Daniel
D
Leong
Natalie
N
Hresko
Timothy
T
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