Submuscular plating of femoral fractures in children: the importance of anatomic plate precontouring.

Despite many treatment options, the treatment of metaphyseal pediatric femoral fractures remains to be controversial. Fixation of most metaphyseal femoral fractures in older children is difficult to perform. Recently, bridging fixation of such fractures by submuscular plating has become popular. Plate precontouring as close as possible to anatomic bony structure is important, as the femur will subsequently reduce to the contour of the plate with screw placement. Our technique is using plates that are anatomically precontoured to a cadaver adolescent femur to ensure proper postoperative alignment. In this study we evaluate the effectiveness of submuscular plating performed in our institution using this technique, in 11 patients. All fractures united with good alignment. No major complication occurred. In conclusion, submuscular plating of adolescent femoral fractures with precontoured plates is an effective, predictable, and safe procedure.