Syed Arsalan Haider Bukhari.
Minimally invasive plate osteosynthesis of paediatric proximal lateral femoral fractures with locked compression plate.
J Surg Pak Jan ;15(4):167-70.

Objective To evaluate the effectiveness of internal fixation with locked compression plate (LCP) applied with minimally invasive plate osteosynthesis (MIPO) technique in proximal lateral femur fractures in children. Study design Descriptive case series. Place & Duration of study Department of Orthopaedics Combined Military Hospital Lahore, from April 2009 to April 2010. Methodology Children, who presented with Colonna type IV fractures in the proximal region of femur were treated with 3.5 mm LCP fixation by MIPO technique. The locking head screw (LHS) was introduced through the LCP into the neck of femur. In cases where the fracture was too proximal or comminuted, an attempt was made to apply a cancellous de-rotation screw into the neck of the femur through proximal most hole of the LCP. In patients where the neck size allowed passage of only one LH screw, a supporting hip spica was applied to avoid rotation. Patients were evaluated to determine complications, clinical and radiological outcome. All the patients were followed up at two weekly intervals for first month and then four weekly for 2 months and six monthly for one year. The implant in all patients were planned to be removed after one year. Results Eighteen children (males 16, females 2) between ages of 7 to 12 years were managed. At a mean postoperative follow up of 3 months, good callus union was achieved in all cases. One female patient had mild coxa valga (due to plate over bend) and one male developed superficial wound infection. In one male patient there was posterior displacement of a fracture fragment in comminuted fracture. No avascular necrosis of the head of femur or premature physeal closure was noted. Fifteen patients had excellent results while three patients had good results in term of weight bearing and gait. Conclusions The method of early stable internal fixation of paediatric lateral proximal femur fractures, utilizing contoured 3.5 mm LCP bend to measurements, coupled with MIPO, was safe with gratifying results.

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