Early Failure of Locking Compression Plates in Pediatric Proximal Femoral Fracture

Abstract

Background: Although proximal femoral locking compression plates (PF-LCP) have been used with increasing frequency in the fixation of proximal femoral fractures in the pediatric population, there is a lack of literature regarding their use. The purpose of this study was to examine the failure rates of PF-LCP fixation in comparison to other accepted fixation methods within a pediatric population.Methods: Retrospective review identified consecutive children treated for proximal femoral fractures from September 2008 to February 2019, who had a minimum follow-up of 12 weeks. Patient charts and radiographs were reviewed, and demographic information was compiled. In the case of failures, timing and method of failure were documented.Results: Sixty-four proximal femoral fractures (61 children) were studied. The average age at the time of presentation was 10.4 years. Twenty-six fractures were treated with PF-LCPs and 38 with other fixation methods (compression hip screws, rigid locked intramedullary nailing, cannulated screws, or a combination of hip screw side plate and intramedullary nailing). Failure occurred in four of the 26 fractures treated with locking compression plating (15.4%) compared to none of the 38 treated with other fixation types (p<0.05).Conclusions: This study demonstrates a higher rate of failure in proximal femoral fractures, particularly basicervical and transcervical femoral neck fractures, treated with locking compression plates (12.9%) compared to 0% other fixation methods (no failures). As a result of this study, we no longer use locked plating systems for pediatric femoral neck fractures at our institution.Level of Evidence: Level III Key Concepts•Proximal femoral fractures account for less than 1% of all fractures in children.•Locking compression plates are being more frequently used in pediatric proximal femoral fractures.•Outcome studies are limited because of the low incidence of these fractures and relative recent introduction of this fixation method.•Proximal femoral compression locking plates had a higher rate of early mechanical failure than other fixation modalities in this study.•The increased risk of failure with proximal femoral compression locking plates should be considered before opting for these implants.