title: 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. A few centers have reported that submuscular bridge plating (SBP) is associated with minimal complications, but these findings require confirmation.
  
  
  OBJECTIVE
  We asked whether SBP (1) reproducibly leads to union in unstable fractures with a low complication rate, (2) leads to reasonable alignment and leg length equality (3), is unaffected by age, weight, or location of fracture, and (4) is associated with no or minimal refracture after hardware removal.
  
  
  METHODS
  We retrospectively reviewed 60 fractures in 58 patients with pediatric diaphyseal femoral fractures treated with SBP from 1999 to 2011. The average age was 9 years. Forty (67%) of the fractures were unstable. Minimum followup was 2.4 months (average, 15.5 months; range, 2.4-50.6 months).
  
  
  RESULTS
  All fractures healed well and all patients returned to full activity. Two of the 58 patients (3%) had major complications leading to unplanned surgeries: one implant failure and one deep infection in an old open fracture. None of the patients developed clinically important malalignment or leg length discrepancy. Implant removal was performed in 49 patients without complications.
  
  
  CONCLUSIONS
  SBP provided reliable fixation and healing for complex pediatric femur fractures and can have a broader application in the orthopaedic community. SBP is our preferred method for unstable fractures or fractures of the proximal and distal shaft.
authors.affiliation: Department of Orthopaedic Surgery & Rehabilitation, Texas Tech University Health Sciences Center, 4800 Alberta Avenue, El Paso, TX 79905-2700, USA. amratef@doctor.com
authors.forename: Amr A
authors.initials: AA
authors.lastname: Abdelgawad
authors.forename: Ryan N
authors.initials: RN
authors.lastname: Sieg
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Laughlin
authors.forename: Juan
authors.initials: J
authors.lastname: Shunia
authors.forename: Enes M
authors.initials: EM
authors.lastname: Kanlic
mesh_terms: D000293:Adolescent; D001860:Bone Plates; D002648:Child; D002675:Child, Preschool; D005260:Female; D005264:Femoral Fractures / Q000601:surgery*; D005269:Femur / Q000601:surgery*; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods*; D017102:Fracture Healing; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome
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