PAPER 190: PERCUTANEOUS BRIDGE PLATING FOR PEDIATRIC FEMORAL DIAPHYSEAL FRACTURES

Abstract

Purpose: Pediatric femoral fracture treatment is varied. Each treatment has advantages and disadvantages. The goal of treatment is to avoid complications, reduce costs, and return function. Percutaneous bridge plating has many advantages and little disadvantages. The purpose of this study was to examine the results of percutaneous bridge plating for pediatric femoral diaphyseal fractures.

Method: Over a 4-year time span (2002–2005), all pediatric femoral fractures were diagnosed. A retrospective chart review was completed and only percutaneous bridge plating treatment was analyzed.

Results: 78 fractures were noted in 73 patients. Average age was 9 (range 3–16). Gender was 56 males and 22 females. Most common mechanisms were falls 15 (19%), MVA 12 (15%), and pedestrians 9 (12%). Four fractures (5%) were open. Forty-three fractures (61%) were associated with polytrauma. Time to operation averaged 1 day (0–11 days, 89% 0–1 day). Most plates were 3.5 combi locked plates with a lesser but equal number of 3.5 DCP and 4.5 DCP. Length of stay averaged 5 days (range 0–45 days, 18% 0–1 day, 58% 2–4 days). The majority of patients (58%) began weight bearing at 2–6 weeks. Callus formation began at 2–6 wks (84%). Fracture healing occurred by 6 weeks in 91%. Limp was resolved by 3 months in 54%. Pain was resolved by 3 months in 90%. Patients were back to active daily living without restrictions by 3 months in 96% of the fractures. Complications were noted with 4 superficial wounds, 4 problematic scars, 3 leg overgrowth < 12 mm, and 3 distal prominent plates. No nonunions or refractures were noted. Hardware (HW) was removed on average by 6 months (range 3 mo to never). Outpatient percutaneous HW removal was performed in 100% of the cases.

Conclusion: Percutaneous bridge plating for pediatric femoral fractures is predictable and effective with minimal complications. Asymptomatic femoral overgrowth was minimal.