Results and technique of unstable pediatric femoral fractures treated with submuscular bridge plating.

Twenty-seven patients underwent submuscular bridge plating for unstable pediatric femoral fractures with contraindications to fixation with flexible intramedullary nails. This report discusses the technique and results. A precontoured plate was tunneled proximally through a small distal incision in the subvastus plane to bridge the fracture. The plate was secured to the femur, with screws placed percutaneously proximal and distal to the fracture to reduce and stabilize the fracture. A retrospective review of radiographs and clinical follow-up was analyzed for postoperative alignment, any change in alignment or instrumentation failure, bony union, clinical exam, and complications. There were no intraoperative or postoperative complications. There has been no instrumentation failure or loss of reduction. Early callus was seen by 6 to 8 weeks and stable bony union by 12 weeks in all patients. Submuscular plating is a reasonable option for operative stabilization of comminuted and unstable pediatric femoral fractures.