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Submuscular Bridge Plating for Management of Pediatric Femur Fractures

March 01, 2019

Contributors: Ahmed Elabd, MD; Isaac Fernandez, MD; Ahmed Thabet Hagag, MD; Enes M Kanlic, MD; Amr Atef Abdelgawad, MD; Amr Atef Abdelgawad, MD

2019 HONORABLE MENTION Complex, high-energy, diaphyseal pediatric femur fractures cannot be reliably managed using conventional methods. Casting is not suitable for the treatment of polytrauma patients and large children. External fixation is associated with a high rate of malalignment and refracture. Elastic nails are not suitable for the management of unstable fractures and metaphyseal fractures. Rigid lateral trochanteric nails do not address proximal and distal fragments and require a relatively large medullary canal. A few medical centers have reported that submuscular bridge plating is associated with minimal complications; however, these findings require confirmation. This video presents a submuscular bridge plating technique that is used by the surgeons at our level I trauma center to successfully manage pediatric femur fractures. In addition, the video discusses a study in which we determine if submuscular bridge plating reproducibly leads to union with a low rate of complications in patients with an unstable fracture; leads to reasonable alignment and leg length equalization; is unaffected by patient age, patient weight, and fracture location; and is associated with no or minimal refracture after hardware removal.

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