Pediatric Subtrochanteric Fracture Treated with Adult Proximal Humerus Locking Plate: A Case Series and Literature Review
Abstract
Background: A variety of options including titanium elastic nails (TENs) and locking plates (LPs) are available for the internal fixation of subtrochanteric fractures (STFs). However, the preferred treatment option among children and adolescents is still controversial. Methods: We report four cases of STFs in school-aged pediatric patients, treated with an adult proximal humerus LP.
Results: Based on the Flynn scoring system at the last follow-up visit, all patients exhibited excellent clinical outcomes, along with satisfactory radiological outcomes based on the Beaty scoring system. There were no complications.
Conclusion: Our findings suggest the efficacy of using adult proximal humerus LPs in treating pediatric STFs. The advantage of these plates lies in their ability to accommodate many screws at appropriate positions and angles without damaging the physis. This approach holds promise for the management of pediatric STFs.
1. Jarvis J, Davidson D, Letts M. Management of subtrochanteric fractures in skeletally immature adolescents. J Trauma. 2006;60(3):613-9. doi: 10.1097/01.ta.0000197606.63124.9e. [PubMed: 16531863].
2. Loizou CL, McNamara I, Ahmed K, Pryor GA, Parker MJ. Classification of subtrochanteric femoral fractures. Injury. 2010;41(7):739-45. doi: 10.1016/j.injury.2010.02.018. [PubMed: 20394921].
3. Ireland DC, Fisher RL. Subtrochanteric fractures of the femur in children. Clin Orthop Relat Res. 1975;(110):157-66. doi: 10.1097/00003086-197507000-00020. [PubMed: 1157378].
4. Xu Y, Bian J, Shen K, Xue B. Titanium elastic nailing versus locking compression plating in school-aged pediatric subtrochanteric femur fractures. Medicine (Baltimore). 2018;97(29):e11568. doi: 10.1097/MD.0000000000011568. [PubMed: 30024559]. [PubMed Central: PMC6086543].
5. Shah MD, Kapoor CS, Soni RJ, Patwa JJ, Golwala PP. Evaluation of outcome of proximal femur locking compression plate (PFLCP) in unstable proximal femur fractures. J Clin Orthop Trauma. 2017;8(4):308-12. doi: 10.1016/j.jcot.2016.11.005. [PubMed: 29062210]. [PubMed Central: PMC5647620].
6. Gogna P, Mohindra M, Verma S, Thora A, Tiwari A, Singla R. Adult proximal humerus locking plate for fixation of paediatric subtrochanteric fractures. Musculoskelet Surg. 2014;98(3):189-94. doi: 10.1007/s12306-013-0310-z. [PubMed: 24402680].
3rd
8. Flynn JM, Luedtke LM, Ganley TJ, Dawson J, Davidson RS, Dormans JP, et al. Comparison of titanium elastic nails with traction and a spica cast to treat femoral fractures in children. J Bone Joint Surg Am. 2004;86(4):770-7. doi: 10.2106/00004623- 200404000-00015. [PubMed: 15069142].
9. Beaty JH. Femoral-Shaft Fractures in Children and Adolescents. J Am Acad Orthop Surg. 1995;3(4):207-17. doi: 10.5435/00124635- 199507000-00003. [PubMed: 10795027].
10. Baumgaertner MR, Curtin SL, Lindskog DM. Intramedullary versus extramedullary fixation for the treatment of intertrochanteric hip fractures. Clin Orthop Relat Res. 1998;(348):87-94. [PubMed: 9553538].
11. Caglar C, Akcaalan S, Bozer M, Akkaya M. Adult Proximal Humeral Locking Plate Is a Good Alternative Option in the Treatment of Adolescent Subtrochanteric Femur Fractures: A Case Series and Literature Review. Hip Pelvis. 2022;34(4): 245-54. doi: 10.5371/hp.2022.34.4.245. [PubMed: 36601609]. [PubMed Central: PMC9763829].
12. Patrikov K, Georgiev H, Kehayov R. Pathological fractures of the proximal femur in children and adolescents treated with LCP paediatric hip plate. Acta Chir Orthop Traumatol Cech. 2022;89(1):68-74. [PubMed: 35247247].
13. Tsutsumi R, Mammoto T. Pediatric pathological subtrochanteric fracture treated with an adult proximal humerus polyaxial locking plate: A case report. SAGE Open Med Case Rep. 2022;10:2050313X221093112. doi: 10.1177/2050313X221093112. [PubMed: 35465021]. [PubMed Central: PMC9021574].
14. Danisman M, Ozdemir E, Dursun G, Ayvaz M, Yilmaz G. An alternative fixation option for subtrochanteric femur fractures in children: Adult proximal humerus plate. J Pediatr Orthop. 2022;42(8):e828-e832. doi: 10.1097/BPO.0000000000002207. [PubMed: 35834366].
15. Chetia NP, Medhi H, Das M, Bidyananda A. Outcome of adult proximal humerus locking plate in the treatment of paediatric subtrochanteric fractures. Int J Res Orthop. 2020;6(1):63. doi: 10.18203/issn.2455-4510.IntJResOrthop20195796.
16. Newbury AJ, Aurigemma P, Kraus M, Most M. The repair of an acute pathological subtrochanteric femur fracture using an adult 3.5-mm Proximal humerus locking plate in an adolescent patient: A case report. JBJS Case Connect. 2020;10(2):e0491. doi: 10.2106/JBJS.CC.19.00491. [PubMed: 32649111].
17. Chew J, Phang Z, Ooi B. Paediatric subtrochanteric femur fracture treated with PHILOS plate: A case report. Hong Kong J Orthop Res. 2018;1(1): 1-3.
18. Kumar M, Chandrabau KK, Bhaskaran VK, Jindal RC. Unusual proximal femur fracture in children treated with PHILOS plate and review of literature. J Orthop Allied Sci. 2017;5(1):6-9. doi: 10.4103/joas.joas_32_16.
19. Jusoh M. Adult PHILOS humeral plate for the fixation of paediatric proximal femur fracture. Proceedings of the 50th Anniversary: Golden Jubilee Celebration of Malaysian Orthopaedic Association and 47th Annual Scientific Meeting / Annual General Meeting 2017 May 18-21; Kuala Lumpur, Malaysia.
20. Shaw CR, Badhesha J, Ayana G, Abu-Rajab R. Use of a proximal humeral plate for a paediatric peri-prosthetic femoral fracture. J Surg Case Rep. 2014;2014(7): rju069. doi: 10.1093/jscr/rju069. [PubMed: 24986984]. [PubMed Central: PMC4077020].
21. Cortes LE, Triana M, Vallejo F, Slongo TF, Streubel PN. Adult proximal humerus locking plate for the treatment of a pediatric subtrochanteric femoral nonunion: A case report. J Orthop Trauma. 2011;25(7):e63-7. doi: 10.1097/BOT.0b013e3181f8d9c3. [PubMed: 21577158].
22. Li Y, Heyworth BE, Glotzbecker M, Seeley M, Suppan CA, Gagnier J, et al. Comparison of titanium elastic nail and plate fixation of pediatric subtrochanteric femur fractures. J Pediatr Orthop. 2013;33(3):232-8. doi: 10.1097/BPO.0b013e318288b496. [PubMed: 23482257].
23. Hong P, Zhao X, Ze R, Rai S, Liu R, Li J, et al. Operative choice for subtrochanteric femoral fracture in school-aged children: Triple elastic stable intramedullary nail versus locking plate. Front Pediatr. 2022;10:894262. doi: 10.3389/fped.2022.894262. [PubMed: 35958179]. [PubMed Central: PMC9360405].
24. Caglar O, Ozdemir E, Tokgozoglu AM, Atilla B. Use of proximal humerus plates for the fixation of the subtrochanteric femoral shortening osteotomy during total hip arthroplasty for Crowe type IV developmental dysplasia of the hip patients. Jt Dis Relat Surg. 2020;31(2):306-11. doi: 10.5606/ehc.2020.73078. [PubMed: 32584730]. [PubMed Central: PMC7489172].
2. Loizou CL, McNamara I, Ahmed K, Pryor GA, Parker MJ. Classification of subtrochanteric femoral fractures. Injury. 2010;41(7):739-45. doi: 10.1016/j.injury.2010.02.018. [PubMed: 20394921].
3. Ireland DC, Fisher RL. Subtrochanteric fractures of the femur in children. Clin Orthop Relat Res. 1975;(110):157-66. doi: 10.1097/00003086-197507000-00020. [PubMed: 1157378].
4. Xu Y, Bian J, Shen K, Xue B. Titanium elastic nailing versus locking compression plating in school-aged pediatric subtrochanteric femur fractures. Medicine (Baltimore). 2018;97(29):e11568. doi: 10.1097/MD.0000000000011568. [PubMed: 30024559]. [PubMed Central: PMC6086543].
5. Shah MD, Kapoor CS, Soni RJ, Patwa JJ, Golwala PP. Evaluation of outcome of proximal femur locking compression plate (PFLCP) in unstable proximal femur fractures. J Clin Orthop Trauma. 2017;8(4):308-12. doi: 10.1016/j.jcot.2016.11.005. [PubMed: 29062210]. [PubMed Central: PMC5647620].
6. Gogna P, Mohindra M, Verma S, Thora A, Tiwari A, Singla R. Adult proximal humerus locking plate for fixation of paediatric subtrochanteric fractures. Musculoskelet Surg. 2014;98(3):189-94. doi: 10.1007/s12306-013-0310-z. [PubMed: 24402680].
3rd
8. Flynn JM, Luedtke LM, Ganley TJ, Dawson J, Davidson RS, Dormans JP, et al. Comparison of titanium elastic nails with traction and a spica cast to treat femoral fractures in children. J Bone Joint Surg Am. 2004;86(4):770-7. doi: 10.2106/00004623- 200404000-00015. [PubMed: 15069142].
9. Beaty JH. Femoral-Shaft Fractures in Children and Adolescents. J Am Acad Orthop Surg. 1995;3(4):207-17. doi: 10.5435/00124635- 199507000-00003. [PubMed: 10795027].
10. Baumgaertner MR, Curtin SL, Lindskog DM. Intramedullary versus extramedullary fixation for the treatment of intertrochanteric hip fractures. Clin Orthop Relat Res. 1998;(348):87-94. [PubMed: 9553538].
11. Caglar C, Akcaalan S, Bozer M, Akkaya M. Adult Proximal Humeral Locking Plate Is a Good Alternative Option in the Treatment of Adolescent Subtrochanteric Femur Fractures: A Case Series and Literature Review. Hip Pelvis. 2022;34(4): 245-54. doi: 10.5371/hp.2022.34.4.245. [PubMed: 36601609]. [PubMed Central: PMC9763829].
12. Patrikov K, Georgiev H, Kehayov R. Pathological fractures of the proximal femur in children and adolescents treated with LCP paediatric hip plate. Acta Chir Orthop Traumatol Cech. 2022;89(1):68-74. [PubMed: 35247247].
13. Tsutsumi R, Mammoto T. Pediatric pathological subtrochanteric fracture treated with an adult proximal humerus polyaxial locking plate: A case report. SAGE Open Med Case Rep. 2022;10:2050313X221093112. doi: 10.1177/2050313X221093112. [PubMed: 35465021]. [PubMed Central: PMC9021574].
14. Danisman M, Ozdemir E, Dursun G, Ayvaz M, Yilmaz G. An alternative fixation option for subtrochanteric femur fractures in children: Adult proximal humerus plate. J Pediatr Orthop. 2022;42(8):e828-e832. doi: 10.1097/BPO.0000000000002207. [PubMed: 35834366].
15. Chetia NP, Medhi H, Das M, Bidyananda A. Outcome of adult proximal humerus locking plate in the treatment of paediatric subtrochanteric fractures. Int J Res Orthop. 2020;6(1):63. doi: 10.18203/issn.2455-4510.IntJResOrthop20195796.
16. Newbury AJ, Aurigemma P, Kraus M, Most M. The repair of an acute pathological subtrochanteric femur fracture using an adult 3.5-mm Proximal humerus locking plate in an adolescent patient: A case report. JBJS Case Connect. 2020;10(2):e0491. doi: 10.2106/JBJS.CC.19.00491. [PubMed: 32649111].
17. Chew J, Phang Z, Ooi B. Paediatric subtrochanteric femur fracture treated with PHILOS plate: A case report. Hong Kong J Orthop Res. 2018;1(1): 1-3.
18. Kumar M, Chandrabau KK, Bhaskaran VK, Jindal RC. Unusual proximal femur fracture in children treated with PHILOS plate and review of literature. J Orthop Allied Sci. 2017;5(1):6-9. doi: 10.4103/joas.joas_32_16.
19. Jusoh M. Adult PHILOS humeral plate for the fixation of paediatric proximal femur fracture. Proceedings of the 50th Anniversary: Golden Jubilee Celebration of Malaysian Orthopaedic Association and 47th Annual Scientific Meeting / Annual General Meeting 2017 May 18-21; Kuala Lumpur, Malaysia.
20. Shaw CR, Badhesha J, Ayana G, Abu-Rajab R. Use of a proximal humeral plate for a paediatric peri-prosthetic femoral fracture. J Surg Case Rep. 2014;2014(7): rju069. doi: 10.1093/jscr/rju069. [PubMed: 24986984]. [PubMed Central: PMC4077020].
21. Cortes LE, Triana M, Vallejo F, Slongo TF, Streubel PN. Adult proximal humerus locking plate for the treatment of a pediatric subtrochanteric femoral nonunion: A case report. J Orthop Trauma. 2011;25(7):e63-7. doi: 10.1097/BOT.0b013e3181f8d9c3. [PubMed: 21577158].
22. Li Y, Heyworth BE, Glotzbecker M, Seeley M, Suppan CA, Gagnier J, et al. Comparison of titanium elastic nail and plate fixation of pediatric subtrochanteric femur fractures. J Pediatr Orthop. 2013;33(3):232-8. doi: 10.1097/BPO.0b013e318288b496. [PubMed: 23482257].
23. Hong P, Zhao X, Ze R, Rai S, Liu R, Li J, et al. Operative choice for subtrochanteric femoral fracture in school-aged children: Triple elastic stable intramedullary nail versus locking plate. Front Pediatr. 2022;10:894262. doi: 10.3389/fped.2022.894262. [PubMed: 35958179]. [PubMed Central: PMC9360405].
24. Caglar O, Ozdemir E, Tokgozoglu AM, Atilla B. Use of proximal humerus plates for the fixation of the subtrochanteric femoral shortening osteotomy during total hip arthroplasty for Crowe type IV developmental dysplasia of the hip patients. Jt Dis Relat Surg. 2020;31(2):306-11. doi: 10.5606/ehc.2020.73078. [PubMed: 32584730]. [PubMed Central: PMC7489172].
| Files | ||
| Issue | Vol 10 No 2 (2024) | |
| Section | Research Articles | |
| DOI | https://doi.org/10.18502/jost.v10i2.15517 | |
| Keywords | ||
| Femoral fractures Proximal Femoral Fractures Hip Fractures Fracture Fixation Internal Fracture Fixation | ||
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How to Cite
1.
Zandi R, Talebi S, Mehrvar A, Nodehi S, Ehsani A. Pediatric Subtrochanteric Fracture Treated with Adult Proximal Humerus Locking Plate: A Case Series and Literature Review. J Orthop Spine Trauma. 2024;10(2):87-90.
