Submuscular plates versus flexible nails in preadolescent diaphyseal femur fractures

L. K. Chen, B. T. Sullivan, P. D. Sponseller

Research output: Contribution to journalArticlepeer-review


Purpose To compare patient characteristics, operative time, estimated blood loss (EBL), postoperative length of hospital stay (LOS) and complications after insertion and removal of submuscular plates (SMPs) versus flexible nails (FNs) for paediatric diaphyseal femur fractures. Methods We reviewed records of 58 children (mean age, 7.7 years SD 2.0) with diaphyseal femur fractures who underwent treatment with SMPs (n = 30) or FNs (n = 28) from 2005 to 2017 (mean follow-up, 22 months SD 28). Patients with pathological fractures or musculoskeletal comorbidities were excluded. Alpha = 0.05. Results Insertion of FNs was associated with shorter operative time (ß = -24 mins) and less EBL (ß = -38 mL) (both, p < 0.001) compared with insertion of SMPs, after adjusting for fracture type and time from beginning of study period. Removal of FNs was also associated with shorter operative time (ß = -15 min) compared with removal of SMPs (p < 0.001). EBL during removal was similar between groups (p = 0.080). The FN group had a shorter LOS after insertion (ß = -0.2 d) compared with the SMP group (p = 0.032). Four patients treated with SMPs and three treated with FNs developed surgical site infections. Two patients treated with SMPs and seven treated with FNs experienced implant irritation that re-solved with removal. No other complications occurred. Conclusion Compared with SMPs, FNs were associated with shorter operative time (for insertion and removal), less EBL (for insertion) and shorter post-insertion LOS in patients with diaphyseal femur fractures.

Original languageEnglish (US)
Pages (from-to)488-492
Number of pages5
JournalJournal of Children's Orthopaedics
Issue number5
StatePublished - Oct 2018


  • Diaphyseal femur fracture
  • Flexible nailing
  • Skeletally immature children
  • Submuscular plating
  • Surgical characteristics

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Orthopedics and Sports Medicine


Dive into the research topics of 'Submuscular plates versus flexible nails in preadolescent diaphyseal femur fractures'. Together they form a unique fingerprint.

Cite this