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A 2-month-old female with displaced, spiral, mid-diaphyseal femur fracture
0%
7/3571
A 26-month-old boy with a displaced spiral mid-diaphyseal femur fracture with <2cm shortening
1%
29/3571
A 7-year old boy with a transverse, non-comminuted mid-diaphyseal femur fracture
3%
100/3571
A 7-year-old boy with a highly comminuted mid-diaphyseal femur fracture
83%
2974/3571
A 15-year-old girl with a displaced butterfly fragmented mid-diaphyseal femur fracture
8%
273/3571
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Submuscular bridge plating is appropriate for length-unstable femur fractures in skeletally immature patients ages 6 years and older. Traditional plating of diaphyseal femur fractures in children has been abandoned due to the large incision and significant periosteal stripping involved. Submuscular plating with limited incisions and percutaneously applied fixation is a more biologically friendly way to achieve rigid internal fixation in length-unstable fracture patterns. External fixation is another acceptable option for these fractures. Locked plating, on the other hand, provides an 'internal external fixator,' avoids pin site issues and allows rapid mobilization while providing a biologically favorable environment for healing. Kocher et al. provide the AAOS Clinical Practice Guideline for the treatment of pediatric diaphyseal femur fractures. They concluded that there was insufficient evidence regarding submuscular bridge plating to include it in the guideline. Flynn et al. review the management of pediatric femoral shaft fractures. The note that the narrow indications for plating of pediatric femoral fractures are open fractures, multiple trauma, head injury or compartment syndrome in patients less than 12 years old. Plating allows rigid fixation with readily available equipment and allows for rapid mobilization. Hedequist et al. present a Technical Tricks paper in which they detail their surgical technique for submuscular bridge plating. They recommend this fixation strategy for patients between age 6 and skeletal maturity with comminuted diaphyseal femur fractures that are not easily treated by other methods. Illustration A shows a preoperative and postoperative radiograph of a comminuted pediatric femur fracture treated with submuscular plating. Incorrect answers: Answer 1: Children less than 6 months may be treated with spica casting or Pavlik harness. Pavlik is generally favored due to its ease of application and use and lower risk of skin complications Answer 2: This patient is most appropriately treated with spica casting. Answer 3: Length stable fractures can be treated with flexible intramedullary nails Answer 5: Skeletally mature patients with mid-diaphyseal femur fractures should be treated rigid intramedullary nails
3.8
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