Comparison of efficiency between submuscular plating and external fixation of spiral and comminuted fractures of the femur in 6-12 years old pediatric patients

Objective: The treatment of femoral diaphyseal fractures in children 6 to 12 years of age has changed substantially over the last two decades and continues to evolve. Although external fixation and submuscular plating have been extensively used in the management of pediatric femur fractures, there are few studies which have compared the results of external fixation and submuscular bridge plating in pediatric closed unstable spiral femoral diaphyseal fractures. Patients and Method: Two groups of patients treated by external fixator or submuscular plating due to femoral diaphyseal spiral and comminuted fractures were included in our study. Twenty patients comprised the external fixation group and 26 patients the submuscular bridge plating group. The patients were evaluated for mechanism of injury, knee ROM, length of hospital stay, clinical and radiological findings and complications. The average follow-up period was 2 (range: 1.5 to 4) years. Results: Age of the patients ranged from 6 to 11 (average: 7.45) years in the external fixator group and from 7 to 12 (average: 9.08) years in the submuscular plating group. In the external fixator group, the fixator was removed at an average of 12.2 weeks. In the submuscular plating group, radiographic union was detected at an average time of 10 weeks. Pin site infection was common in the external fixator group. Patients were given knee ROM rehabilitation for knee contracture. No refracture was observed in the external fixator and submuscular plating groups. Conclusion: The main point to consider in external fixator use in pediatric femur fractures is refracture after fixator removal, which is mostly seen in transverse and open fractures. Use of the external fixator in spiral fractures and removing the fixator following bone healing in four cortices may prevent refracture complication. It is the surgeon’s choice to decide between the two treatment modalities to operate on the femur fracture. Although we found similar results between external fixator and plate in pediatric femur shaft fractures; we think large population based studies are needed in order to comparison.