Pediatric Extra-Articular Proximal Femoral Fracture Fixation With a Submuscular Non-Locking Plate.

Background: Submuscular plating with use of a non-locking plate is indicated for the treatment of extra-articular proximal femoral fractures in children ≥6 up to 14 years old. There is no specific weight limit for the use of this procedure. The aim of the procedure is fracture stabilization and facilitation of fracture union through the use of a minimally invasive approach Description: The surgical technique is performed with the patient under general anesthesia and in the supine position on a fracture table. A stainless steel non-locking dynamic compression plate (4.5-mm system) is placed on the anterior aspect of the thigh and examined with use of a C-arm to confirm that the chosen length is appropriate, then placed along the lateral aspect of the thigh under C-arm visualization to determine the site for proximal contouring. Proximal plate contouring is performed with use of a plate bender. Through a distal incision, a submuscular tunnel is made. A proximal incision is then made over the greater trochanter. The plate is slid from the distal to the proximal end. The plate is temporarily stabilized with use of Kirschner wires via the proximal and distal holes. After confirming the plate position with use of the C-arm, non-locking screws are placed first on the distal and then on the proximal end of the plate. A total of 3 screws are inserted into each of the distal and proximal fragments Alternatives: Alternatives for treating pediatric extra-articular proximal femoral fractures include the use of titanium elastic nails, rigid intramedullary nails, locking plates, limited-contact dynamic compression plates, and external fixators Rationale: Extra-articular proximal femoral fractures by definition include fractures of the subtrochanteric region Expected Outcomes: The results of this technique in 15 patients have been published Important Tips: It is important to achieve length and coronal and rotational alignment, and use the correct plate size and place it appropriately.Avoid excessive bending of the plate as it may produce varus or valgus malalignment.Choose the correct length of the plate in order to achieve stable fixation.Do not open the fracture site, as it preserves the hematoma and provides biological fixation. It is critical to stay extraperiosteal and to place the plate on the lateral surface of the femur.Keep the patient non-weight-bearing until early callus is radiographically visible. Premature weight-bearing should be avoided. Acronyms and Abbreviations: EPFF = extra-articular proximal femoral fractureDCP = dynamic compression plateAP = anteroposteriorK-wire = Kirschner wireORIF = open reduction and internal fixation.