Better outcomes seen with submuscular plating vs IM nailing
Investigators found faster times to union and full weight-bearing and a low complication rate for pediatric patients with diaphyseal femur fractures treated with submuscular plating compared with patients treated with either flexible or rigid intramedullary nails.

Researchers retrospectively reviewed data for 196 skeletally immature patients treated for a total of 198 femur fractures with either submuscular plating, flexible intramedullary (IM) nailing or rigid IM nailing. The mean follow-up was 48 weeks. Investigators compared the treatments for malunion, nonunion, heterotopic ossification, avascular necrosis, limb length discrepancy, residual limp, painful hardware and infection. They also assessed time to union and time to full weight-bearing.

Results showed increased incidences of malunion and hardware irritation with flexible IM nailing. The method was also linked with longer time to full weight-bearing. At the 12-week follow-up, investigators noted rigid IM nailing correlated with an increased incidence of limping. Heterotopic ossification was seen in 23.5% of patients treated with rigid nailing. The quickest return to full weight-bearing was seen for patients treated with submuscular plating. The group also showed the fastest time to healing. ? by Monica Jaramillo