Short-term outcomes of submuscular bridge plating of length-unstable paediatric femoral shaft fractures in children: Insights from a South African tertiary hospital setting

Keywords femoral fractures, paediatric, orthopaedic surgery, children

Abstract

Background: Femoral diaphyseal fracture is a common paediatric orthopaedic injury; however, the management of these fractures remains controversial in children between the ages of 6 and 13 years. The preferred approach for children appears to be surgical, enabling early mobilisation. Some studies have reported that submuscular bridge plating (SBP) might be a good alternative treatment method with favourable outcomes. The aim of this study was to determine whether SBP a) leads to union in length-unstable fractures with a low complication rate; b) leads to reasonable alignment and leg length equality; and c) has acceptable clinical outcomes in a South African tertiary hospital setting.


Methods: All patients with predominantly length-unstable femoral diaphyseal fractures who were treated between 1 January 2011 and 31 December 2012 were included in this study. Patients were treated with SBP using standard of care techniques, and hardware removal was performed at approximately eight months post operatively. The nine months post-operative assessment between the affected and unaffected leg was used to assess the effectiveness of the SBP intervention.


Results: A total of 29 patients (mean age 9±2 years) were included. The majority of the fractures (n=27, 93%) were length-unstable. Two patients (7%) had transverse fractures with >2 cm overlap and/or weighing >45 kg. All fractures healed within expected time frames. No overall leg length discrepancy (p=0.94) or coronal mechanical axis deviation (p=0.51) was observed between the affected and unaffected lower limbs at nine months post-surgery. No differences between the operated and non-operated sides were observed for hip flexion (p=0.88), hip external rotation (p=0.36), hip internal rotation (p=0.12) or knee flexion (p=0.96).


Conclusion: SBP provides reliable outcomes in children with diaphyseal femoral fractures and is our preferred method of fixation for a) length-unstable fractures; b) fractures close to the metaphysis; and c) children weighing more than 45 kg.


Level of evidence: Level 4

Author Biographies

J du Toit, Stellenbosch University

MBChB, FC Orth(SA), MSc, PhD; Professor and Head of Division, Division of Orthopaedic Surgery, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa

R Salkinder, Cape Town Mediclinic

MBChB, FC Orth(SA), MMed; Orthopaedic Surgeon, Cape Town Mediclinic, Oranjezicht, Cape Town, South Africa

M C Burger, Stellenbosch University

PhD; Lecturer and Scientific Research Coordinator, Division of Orthopaedic Surgery, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa

G du Preez, Stellenbosch University

MBChB, FC Orth(SA); Senior Specialist, Division of Orthopaedic Surgery, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa

R P Lamberts, Stellenbosch University

MSc, PhD, FECSS; Professor and Head of Orthopaedic Research, Division of Orthopaedic Surgery, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa

Published
2020-08-26
How to Cite
DU TOIT, J et al. Short-term outcomes of submuscular bridge plating of length-unstable paediatric femoral shaft fractures in children: Insights from a South African tertiary hospital setting. South African Orthopaedic Journal, [S.l.], v. 19, n. 3, p. 145-149, aug. 2020. ISSN 2309-8309. Available at: <http://journal.saoa.org.za/index.php/saoj/article/view/358>. Date accessed: 22 sep. 2020.
Section
Paediatric Orthopaedics

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