title: Medial submuscular plating of the femur in a series of paediatric patients: a useful alternative to standard lateral techniques.
abstract: We describe the technique and results of medial submuscular plating of the femur in paediatric patients and discuss its indications and limitations. Specifically, the technique is used as part of a plate-after-lengthening strategy, where the period of external fixation is reduced and the plate introduced by avoiding direct contact with the lateral entry wounds of the external fixator pins. The technique emphasises that vastus medialis is interposed between the plate and the vascular structures. A total of 16 patients (11 male and five female, mean age 9.6 years (5 to 17)), had medial submuscular plating of the femur. All underwent distraction osteogenesis of the femur with a mean lengthening of 4.99 cm (3.2 to 12) prior to plating. All patients achieved consolidation of the regenerate without deformity. The mean follow-up was 10.5 months (7 to 15) after plating for those with plates still in situ, and 16.3 months (1 to 39) for those who subsequently had their plates removed. None developed a deep infection. In two patients a proximal screw fractured without loss of alignment; one patient sustained a traumatic fracture six months after removal of the plate. Placing the plate on the medial side is advantageous when the external fixator is present on the lateral side, and is biomechanically optimal in the presence of a femoral defect. We conclude that medial femoral submuscular plating is a useful technique for specific indications and can be performed safely with a prior understanding of the regional anatomy.
authors.affiliation: Royal Liverpool Children's Hospital, Department of Paediatric Orthopaedic Surgery, Alder Hey, Eaton Road, Liverpool L12 2AP, UK.
authors.forename: S
authors.initials: S
authors.lastname: Nayagam
authors.forename: B
authors.initials: B
authors.lastname: Davis
authors.forename: G
authors.initials: G
authors.lastname: Thevendran
authors.forename: A J
authors.initials: AJ
authors.lastname: Roche
mesh_terms: D000293:Adolescent; D001860:Bone Plates; D002648:Child; D002675:Child, Preschool; D016267:External Fixators; D005260:Female; D005269:Femur / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D007870:Leg Length Inequality / Q000601:surgery*; D008297:Male; D019857:Osteogenesis, Distraction / Q000295:instrumentation / Q000379:methods*; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Distraction; External fixation; Femur; Medial; Plating; Sub-muscular