title: Comparison of submuscular and open plating of pediatric femur fractures: a retrospective review.
abstract: BACKGROUND
  Plate osteosynthesis is an accepted method of treatment of pediatric femur fractures. Historically, open plating has been used. Submuscular bridge plating has gained recent popularity due to the theoretical advantages of decreased operative time, decreased blood loss, and decreased risk for infection. The purpose of this study was to compare submuscular bridge plating to open plating of pediatric femur fractures.
  
  
  METHODS
  We retrospectively reviewed 79 patients (80 treated femur fractures) between 1999 and 2011 that underwent either open plating (58 femur fractures) or submuscular bridge plating (22 femur fractures). The outcome measures evaluated were operative time, estimated blood loss, malunion, leg length discrepancy, time to union, infection, unplanned return to the operating room, and length of hospital stay after surgery.
  
  
  RESULTS
  Among our outcome measures, there was no difference between the 2 groups in terms of operative time, leg length discrepancy, time to union, infection, or length of hospital stay after surgery. There was greater estimated blood loss in the open plating group (P≤0.0001) and greater rotational asymmetry in the submuscular bridge plating group (P=0.005). There was a trend of increased unplanned return to the operating room in the open plating group (5/58 vs. 0/22) although not statistically significant (P=0.32).
  
  
  CONCLUSIONS
  Submuscular bridge plating and open plating seem to be equally viable options for the management of pediatric diaphyseal femur fractures. In this study, open plating had an increase in estimated blood loss and a trend of more unplanned returns to the operating room, whereas submuscular bridge plating had an increase in asymptomatic rotational asymmetry. Further larger, prospective, randomized studies are necessary to further evaluate these operative techniques.
  
  
  METHODS
  Therapeutic Level III.
authors.affiliation: Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA. mdabbott@gmail.com
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Abbott
authors.forename: Randall T
authors.initials: RT
authors.lastname: Loder
authors.forename: Jeffrey O
authors.initials: JO
authors.lastname: Anglen
mesh_terms: D016063:Blood Loss, Surgical; D001860:Bone Plates; D002648:Child; D002675:Child, Preschool; D005260:Female; D005264:Femoral Fractures / Q000601:surgery*; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods*; D017102:Fracture Healing / Q000502:physiology*; D006760:Hospitalization; D006801:Humans; D007870:Leg Length Inequality / Q000453:epidemiology / Q000209:etiology; D007902:Length of Stay; D008297:Male; D061646:Operative Time; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D013997:Time Factors