Segmental Fracture in Younger Children Managed by Submuscular Plating: A Case Report

Introduction: Complex femur fractures in children are rare and occur due to high-energy trauma. Most of these fractures are managed surgically with the primary goal is the restoration of the anatomical alignment. In this report, we describe the management of complex femur fractures in pediatric patients. Case Presentation: A 5-year-old boy who came to the emergency room at Andalas University Hospital with left thigh pain which occurred due to a high-energy traffic accident since 10 hours before admission. From primary survey, patient was in stable condition. From local examination there was discrepancy and angulation on the left thigh with local tenderness. Plain radiographic studies on the left femur showed a segmental diaphyseal fracture. Afterwards, patient underwent open reduction and internal fixation (ORIF) with submuscular plate fixation on the same day. Result: After surgery, discrepancy was inapparent. On one month follow up, healing and rehabilitation was uneventful, with patient being active and no infection spotted. After three months of follow up, abundant callus formation was observed on the follow up x ray. Clinically, patient did not complain any pain, played actively, and range of motion almost returned to normal as shown by near-normal gait and ability to do various of movements. Discussion: Although theoretically segmental fractures are best managed by Titanium Elastic Nailing System (TENS), multiple clinical setting and facilities considerations may sometimes varies the options available. Submuscular plate fixation is a good choice in settings where C-arm is unavailable and appropriate implants are scarce. This is beneficial in terms of attaining a good reduction and fixation especially for complex patterned fracture, although, one must point out the possible shortcomings such as more bleeding and much soft tissue stripping that may hinder healing process. Conclusion: Complex femur fractures in children are uncommon and challenging to manage. Understanding principles of fracture fixation and choosing the best suitable implants for each case allows for excellent functional outcomes and early patients ambulation. Keywords: comminuted, fracture, pediatric, plate fixation