title: Adverse sequelae due to plate retention following submuscular plating for pediatric femur fractures.
abstract: OBJECTIVE
  Submuscular plating has become a common operative treatment of length-unstable pediatric femur fractures. There has been no consensus regarding the need for plate removal after fracture union. The purpose of this report was to describe the potential constellation of findings that may occur with growth after plate retention.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  A retrospective study was done on all patients who underwent a submuscular plate application for a pediatric femur fracture at our institution between 2003 and 2010 by the senior author. We reviewed the clinical and radiographic findings of patients who had returned for problems after being discharged from care after fracture union.
  
  
  RESULTS
  We identified 3 patients who returned after having been discharged from care. All 3 patients had been treated with a distally contoured plate. All patients had findings of stress shielding, leg length discrepancy, valgus deformity of the femur, bony overgrowth of the plate, and screw tip prominence in the medial thigh. All these findings were related to plate migration secondary to the normal growth of the femur. One patient required a corrective osteotomy for significant limb malalignment, and 2 patients required removal of prominent distal screws.
  
  
  CONCLUSIONS
  Submuscular plates that are distally contoured and applied in growing children for femoral fracture fixation should be removed after complete fracture healing to avoid the potential sequelae of plate retention seen with growth.
  
  
  METHODS
  Therapeutic level IV.
authors.affiliation: Department of Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Brian
authors.initials: B
authors.lastname: Kelly
authors.forename: Benton
authors.initials: B
authors.lastname: Heyworth
authors.forename: Yi-Meng
authors.initials: YM
authors.lastname: Yen
authors.forename: Daniel
authors.initials: D
authors.lastname: Hedequist
mesh_terms: D001860:Bone Plates / Q000009:adverse effects*; D002648:Child; D060906:Coxa Valga / Q000175:diagnosis / Q000209:etiology*; D020878:Device Removal; D005264:Femoral Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D005548:Foreign-Body Migration / Q000000981:diagnostic imaging / Q000209:etiology* / Q000517:prevention & control; D005593:Fracture Fixation, Internal / Q000009:adverse effects* / Q000295:instrumentation; D006801:Humans; D007870:Leg Length Inequality / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D008297:Male; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome