Submuscular Bridge Plating for Length-Unstable, Pediatric Femur Fractures

Samora, Walter; Guerriero, Michael; Willis, Leisel; Klingele, Kevin E.

doi:10.1097/bpo.0000000000000092

Cited by 36 publications

(28 citation statements)

References 14 publications

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“…Studies showed that submuscular plating is an effective alternative for the treatment of fractures of unstable length. 4,6,28,29 Samora et al 6 found that submuscular plating produced excellent healing rates, low complication rates, and early return to weight bearing, with mean time to full weight bearing of 7.8 weeks. Similar results were shown in previous series.…”

Section: Discussionmentioning

confidence: 99%

“…Each surgeon used all 3 techniques, including submuscular plating, retrograde flexible intramedullary nailing, and rigid intramedullary nailing. Anterior bowed femoral locking plates (Synthes, West Chester, Pennsylvania; Smith & Nephew, Andover, Massachusetts; and OrthoPediatrics, Warsaw, Indiana) measuring 3.5 and 4.5 mm were used, and the procedure was performed with the 2-incision technique described by Samora et al 6 The surgical techniques for flexible and rigid trochanteric entry and antegrade nailing were described previously. All flexible nail procedures were performed with a retrograde technique with titanium elastic nails (Synthes) (30 procedures) or flexible stainless steel Enders rods (Smith & Nephew, Memphis, Tennessee) (31 procedures) (Figure 1).…”

Section: Methodsmentioning

confidence: 99%

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Pediatric Diaphyseal Femur Fractures: Submuscular Plating Compared With Intramedullary Nailing

Sutphen¹,

Mendoza²,

Mundy³

et al. 2016

Orthopedics

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This study compared the radiographic and clinical outcomes of pediatric diaphyseal femur fractures treated by submuscular plating, flexible retrograde intramedullary nailing, or rigid antegrade intramedullary nailing with a trochanteric entry point in skeletally immature patients who were 8 years and older. A retrospective review was conducted of skeletally immature patients 8 years and older who were treated for femur fracture with submuscular plating, flexible intramedullary nailing, or rigid intramedullary nailing from 2001 to 2014 with a minimum 12-week follow-up. Treatment outcomes were compared for statistical significance, including time to union, malunion, nonunion, heterotopic ossification, avascular necrosis, time to full weight bearing, limb length discrepancy, residual limp, painful hardware, and infection. The study identified 198 femur fractures in 196 patients (mean age, 11.9 years). Each femur fracture was treated with submuscular plating (35), flexible intramedullary nailing (61), or rigid intramedullary nailing (102). Mean follow-up across the cohort was 48 weeks, ranging from 12 to 225 weeks. Flexible nailing was associated with an increased incidence of malunion (P<.0001) and hardware irritation (P=.0204) and longer time to full weight bearing (P=.0018). Rigid nailing was associated with an increased incidence of limp at 12-week followup (P=.0412). Additionally, 23.5% of patients who were treated with rigid nailing had heterotopic ossification. Of all surgical methods, submuscular plating allowed for the most rapid return to full weight bearing (mean, 7 weeks) and offered the fastest healing rate (mean, 6 weeks). Submuscular plating resulted in faster times to union and full weight bearing, with minimal complication rates. Rigid intramedullary nailing with trochanteric entry resulted in a lower incidence of malunion and hardware-related complications; however, these patients had an increased incidence of heterotopic ossification and residual limp postoperatively. Flexible retrograde intramedullary nailing resulted in the highest rates of malunion and hardware irritation and the longest time to full weight bearing. [Orthopedics. 2016; 39(6):353-358.].

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Pediatric Diaphyseal Femur Fractures: Submuscular Plating Compared With Intramedullary Nailing

Sutphen¹,

Mendoza²,

Mundy³

et al. 2016

Orthopedics

Self Cite

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“…Time to full weight bearing has been used as another outcome measure, reported at an average of 8 weeks for compression plating, 7 weeks for submuscular plating, and 12 weeks for flexible nailing [4,12]. However, postoperative weight bearing protocols vary widely between providers and institutions, with some allowing immediate weight bearing with assistive device, others requiring touchdown weight bearing until callus formation, with progressive advancement, and others still preferring non-weight bearing until callus formation [5,[7][8][9][10][11]15].…”

Section: Resultsmentioning

confidence: 99%

“…Though several studies demonstrate consistency in healing time and clinical outcomes between these different fixation methods, postoperative weight bearing protocols vary widely between providers, with some requiring non-weight bearing until evidence of radiographic healing, others allowing touchdown weight bearing for 6 weeks with progressive advancement thereafter, and some even further immobilizing in spica casts [4][5][6][7][8][9][10][11][12]. Periods of weight bearing protected by assistive device also vary depending on surgeon preferences [13].…”

Section: Structionsmentioning

confidence: 99%

How Long Do We Need to Restrict Weight Bearing after Fixation of Pediatric Femur Fractures?

N¹,

A²,

Joseph³

et al. 2020

Int Arch Orthop Surg

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“…In the series of comminuted shaft femur published by Samora et al ., union time in weeks showed a standard deviation of 2.27. 11 Taking this value of standard deviation as baseline, α = 0.05, β = 0.1, and effect size of 2.5, the sample size required to give a statistical power of 90% was found to be 35 (18 in Group A and 17 in Group B). Hence, the authors started the investigation with 19 individuals in each group.…”

Section: Methodsmentioning

confidence: 99%

Titanium Elastic Nailing with Temporary External Fixator versus Bridge Plating in Comminuted Pediatric Femoral Shaft Fractures: A Comparative Study

Dey

Mishra

Nagda³

et al. 2018

IJOO

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Background:High-velocity trauma, associated injuries, risk of iatrogenic devascularization of fragments and need for maintaining alignment upto union make comminuted fracture in pediatric femur a formidable fracture to treat. This comparative study was conducted to evaluate the outcomes of two modes of management in such cases: titanium elastic nailing supplemented with external fixator and submuscular bridge plating (BP).Materials and Methods:Thirty eight children (aged 6–12 years) with comminuted fracture shaft femur who were randomized into two groups underwent systematic evaluation. One group was operated with titanium nailing with temporary external stabilization by fixators (titanium nailing with external [TNE] group) for 4 weeks. The other underwent submuscular BP with locked plates (BP group). Clinical and radiological outcomes, operative time, blood loss, radiation exposure, difficulties in removal and complications were evaluated.Results:Both groups achieved union (10.7 ± 1.9 weeks BP, 11 ± 1.6 weeks TNE), satisfactory knee flexion (138.2 ± 6.4° BP, 136 ± 7.3° TNE), and painless weight bearing (7.3 ± 0.9 weeks vs. 7.3 ± 1.4 weeks) in acceptable alignment. Functional outcomes were excellent in majority of both BP (15 of 19) and nail external fixator groups (15 of 18). Operating time and radiation exposure (69.5 ± 14.5 s vs. 50.9 ± 12.9 s) were more in TNE than in BP (P < 0.01). However, implant removal was more difficult in BP (56.4 ± 12.4 min in BP vs. 30.1 ± 8.8 min TNE). Pin-tract infections (n = 3) and hardware prominence (n = 2) in TNE group and deep infections (n = 2) in BP group were notable complications.Conclusion:Two groups were similar in radiological and functional outcomes. Inserting elastic nails and external fixator was a more exacting surgery, while removal was more difficult in BP group. Both techniques had acceptable success and complication rates.

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Submuscular Bridge Plating for Length-Unstable, Pediatric Femur Fractures

Abstract: Level IV, case series.

Cited by 36 publications

References 14 publications

Pediatric Diaphyseal Femur Fractures: Submuscular Plating Compared With Intramedullary Nailing

Pediatric Diaphyseal Femur Fractures: Submuscular Plating Compared With Intramedullary Nailing

How Long Do We Need to Restrict Weight Bearing after Fixation of Pediatric Femur Fractures?

Titanium Elastic Nailing with Temporary External Fixator versus Bridge Plating in Comminuted Pediatric Femoral Shaft Fractures: A Comparative Study

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