Open plating is less biologically favorable because soft-tissue and especially periosteal stripping will slow fracture healing. In addition, muscle dissection can contribute to discomfort and joint stiffness.
Soft-tissue dissection should be minimized during open plating.
Note on illustrations
Throughout this section generic fracture patterns are illustrated as:
Reduced and provisionally stabilized
Compression vs bridge plating
Transverse and short oblique fractures can be made more stable by compressing using gliding holes in the plate.
Bridge plating relies on indirect fracture reduction.
Most children’s fractures heal readily and compression is not mandatory.
The approach that involves the least dissection of the fracture site to obtain stable fixation is preferred.
2. Selection of implants
For younger children a small fragment set can be used (3.5 mm). For older children and adolescents, a large fragment plate, typically a narrow 4.5 mm plate, can be used.
Select a plate long enough to allow three bicortical screws in each main fragment.
If longer plates are used, a curved plate may provide a better fit and accommodate the sagittal anatomy of the femur.
An x-ray of the contralateral side is useful for templating.
3. Patient preparation and approach
Place the patient in a supine position on a traction table or a translucent table with a bump under the ipsilateral flank.