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Complications of Plate Fixation of Femoral Shaft Fractures In Children and Adolescents

Sunday, October 21, 2012: 8:35 AM
Melrose (Hilton Riverside)
Collin May, M.D., Yi-Meng Yen, M.D., Ph.D, Adam Y. Nasreddine, M.A., Daniel Hedequist, M.D., Michael T. Hresko, M.D. and Benton Heyworth, MD, Orthopaedic Surgery, Children's Hospital Boston, Boston, MA

Purpose:  This study aims to critically analyze results and describe the major and minor complications that may be associated with plate fixation of pediatric diaphyseal femur fractures.

Methods:  The medical records of patients (6-15 years-old) who underwent plate fixation of a DFF at a tertiary-care pediatric center between 01/2003 and 12/2010 were reviewed. Demographic and clinical information regarding mechanism of injury, fracture type, and surgical technique were recorded. Radiographic evaluation of bony healing, hardware position, and deformity was performed throughout the study period. All intra-operative and postoperative complications were recorded. Complication incidence and time from surgery to complication were described. Multivariate logistic regression and multivariate Cox regression models were used to assess the association between different variables and the occurrence of a complication. Kaplan Meier survivorship curves were used to evaluate the freedom from a complication with longer follow-up.

Results: Over an 8-year period, 85 skeletally immature patients (83% males, mean age 10.2 y/o) underwent plate fixation for DFF. Overall, complications were identified in 11 patients (13%). Major complications, defined as those resulting in unplanned reoperation (excluding plate/screw removal), occurred in 5 patients (6%) and included: 2 patients (2%) with wound infections requiring irrigation and debridement, 2 patients (2%) with distal femoral valgus deformity leading to osteotomy and hardware removal, respectively, and 1 patient (1%) with a 3 cm leg-length-discrepancy (LLD) requiring epiphyseodesis. Minor complications, defined as those not requiring unplanned operative intervention, occurred in 6 patients (7%) and included: 2 patients (2%) with delayed union, 2 (2%) with symptomatic screw prominence, 1 patient (1%) with a superficial wound infection effectively treated with oral antibiotics, and 1 patient (1%) with valgus malunion, which was asymptomatic at early follow-up. There were no intraoperative complications and no reports of post-operative knee stiffness, shortening, or reoperations to address fracture stability. Fifty-two patients (61%) underwent routine removal of hardware without related complications following fracture union. Overall, complications occurred postoperatively at a mean time of 20 months (range: 0-65 months), though major complications occurred at a later time-point (mean: 29.1 months, range: 0-65 months), than minor complications (mean: 12.5 months, range: 0-40.1 months). Long follow-up was associated with higher occurrence of a complication (p = 0.0012, odds ratio = 1.05, 95% CI: 1.02-1.08).

Conclusions: Plating of pediatric femur fractures is associated with 6% and 7% rates of major and minor complications, respectively. There were minimal long-term sequelae associated with the complications noted. This complication rate compares favorably with the published rate of complications (10-62%) associated with TEN fixation of similar fracture types. Most complications occurred >4 months postoperatively, with major complication occurring at a later time point than minor complications. Long-term follow-up of these patients is recommended to ensure that complications do not go undetected.