Nail-assisted percutaneous plating of pediatric femoral fractures

Traditional operative treatments for pediatric femoral shaft fractures may result in an unacceptable complication rate, especially in patients with complex fractures. Despite requiring the use of fluoroscopy and presenting some technical difficulty, minimally invasive percutaneous plating is an alternative operative method. We retrospectively reviewed 13 consecutive femoral fractures in children (mean age, 9 years) who were treated by a modified technique of percutaneous plating. Six of the fractures were comminuted. Nine children had associated injuries, including four with head trauma. The primary indication for use of percutaneous plating in this pediatric series was a complex fracture in which flexible nailing would be suboptimal. The results were evaluated by a modification of Flynn's criteria. All fractures united without bone grafts (mean, 11 weeks). No patients had residual radiographic angulations greater than 10° or a leg-length discrepancy greater than 5 mm. All patients had excellent final outcomes. There were no major complications such as deep infection or refracture. The technique provided adequate stability for early functional treatment and predictable healing with maintenance of leg length and alignment. Provisional reduction and stabilization of complex pediatric femoral fractures can facilitate definitive percutaneous plating. Level of Evidence: Level IV, therapeutic study. See the guidelines for authors for a complete description of levels of evidence.