Elastic Nailing Research Articles

Functional outcome of distal femoral fractures managed surgically using locking compression plate laterally and augmented with titanium elastic nail system medially

Background: Distal femur fractures are generally due to high velocity trauma particularly form road traffic accidents and fall from height. The treatment of distal femur fractures has evolved from conservative to operative to fixation of both lateral and medial columns of femur.
 Aims and Objective: The aim of this study was to evaluate the functional outcome of operated cases of comminuted fracture of lower end of femur fixed with locking compression plate laterally and augmented with titanium elastic nail system medially.
 Materials and Methods: The present study was a prospective study carried out in Bharati Vidyapeeth Medical College and Hospital, Sangli after approval from institutional ethical committee. In this study, 20 patients with communited fracture of lower end of femur were included on the basis of a predefined inclusion and exclusion criteria. Detailed history was taken and clinical examination was done in all cases. After preanesthetic evaluation and relevant investigations patients were treated by reduction (close or open) and fixation was done by locking compression plate laterally and augmented with titanium elastic nail system medially. Patients were followed up at 6, 10 and 14 weeks for functional outcome by Neer’s scoring system and degree of flexion at knee joint.
 Results: Out of 20 studied cases there were 16 (80%) males and 4 (20%) were females with a M:F ratio of 4:1. The mean age of male patients was found to be 42.81+/-14.79 whereas mean age of female patients was 40.5 +/- 14.36. The mean age of male and female patients was found to be comparable with no statistically significant difference (P=0.78). Most of the patient were diagnosed with the fracture of AO TYPE C3 (7 cases), followed by AO TYPE C1 (4 cases). Full weight bearing was achieved in 8 (40%) patients within 18 weeks whereas remaining 12 (60%) patients required more than 20 weeks for full weight bearing. 14 (70%) patients had excellent outcome whereas, Good, Fair and poor outcomes were seen in 4 (20%), 1 (5%) and 1 (5%) patient. On one-way ANOVA analysis, showed that the flexion was significantly higher in 12 weeks as that of the 6 weeks (P =<0.0001). Further the flexion was significantly higher in 24 weeks as that of the 6 and 12 weeks (P =<0.0001).
 Conclusion: Our study found that locking compression plating laterally augmented with titanium elastic nail system medially for comminuted distal femoral fractures is a good fixation system and provides good angular stability.

Clinical Outcome of Percutaneous IntramedullaryFixationfor Midshaft ClavicularFractures Using Elastic Stable Nails.

This study investigated the clinical outcomes of fixation of displaced middle-third clavicular fractures using percutaneous elastic stable intramedullary nails. This study included sixty patients with a mean age of 26.40 ± 8.91 years (16-53 years) presented with a displaced middle third fracture of the clavicle. According to the Robinson classification, 48 cases (80%) were type 2B1, 9 cases (15%) type 2B2 and 3 case (5%) 2A1. All cases were treated by elastic intramedullary nails and followed up for at least 12 months. At the end of the twelve months' follow-up period, the mean Constant Shoulder score was 95.70 ± 13.55, ranging from 48 to 100. 54 patients (90%) had excellent results, 3 patients (5%) had an adequate result and 3 patients (5%) had a poor result. There was a statistically significant relationship between the final score and age and associated medical conditions. 1. Elastic Stable Intramedullary Nailing is an image-dependent procedure indicated best for young medically free athletes with simple 2-part middle third clavicle fracture. 2. Hammering is not recommended to avoid dorsolateral cortex perforation. 3. The most common complication is medial skin irritation because of the subcutaneous position of the clavicle as well as the sharp end of the cut nail.

Risk factors for refracture of the femoral shaft in children after removal of external fixation

BackgroundExternal fixation is the primary treatment option in children for femoral shaft fractures, such as open femoral or multiple fractures. One complication is refracture, which is the biggest limitation of fixation devices. This study aims to investigate the risk factors associated with refracture after the removal of external fixation devices and decrease the frequency of refracture.Materials and methodsRetrospectively reviewed clinical data of 165 patients treated at our hospital for fresh femoral shaft fractures with external fixation between May 2009 and February 2018 were included in this study. Patients with pathological fractures, fractures of the femoral neck, fractures that were fixed using plates or elastic stable intramedullary nailing, and old fractures, as well as those who underwent postoperative femoral surgery were excluded. Potential risk factors included: patient age, gender, and weight, fracture sides, open or closed fracture, fracture sites, reduction methods, operation time, perioperative bleeding, number and diameter of the screws, and immobilization time. These factors were identified by univariate and logistic regression analyses.ResultsFemoral shaft refracture developed in 24 patients. Univariate analysis revealed that refracture was not statistically significantly associated with any of the above factors, except AO Pediatric Comprehensive Classification of Long Bone Fractures (PCCF) classification type 32-D/4.2 and L2/L3 ratio (L2, length of femur fixed by the two screws farthest from the fracture line; L3, the total length from the greater trochanter to the distal end of femur; P < 0.001 and P = 0.0141, respectively). Multivariate analysis showed that PCCF classification type 32-D/4.2 and L2/L3 ratio were also independent risk factors for femoral refracture.ConclusionsFemoral shaft refracture is relatively common in children treated with external fixation. Because of the limited number of cases in this study, we cautiously concluded that the PCCF classification type 32-D/4.2 and L2/L3 ratio were independent risk factors for femoral shaft refracture in these patients.Level of evidenceIV

Лечебная тактика при переломах ключицы у детей

Introduction One of the most common injuries in children is clavicle fractures. They account for up to 14 % of all pediatric bone injuries. Aim Comparative evaluation of the effectiveness of surgical and conservative methods of treating closed clavicle fractures in children. Materials and methods Between 2011 and 2018, 1,800 children with clavicle fractures referred to the traumatology and orthopedic department at the Children's Clinical Hospital No. 9 in Yekaterinburg. Most of them were treated conservatively, and 94 (5.2 %) children were hospitalized for surgical treatment. Depending on age and type of displacement, children received different conservative treatments, such as Deso dressing in children under two years old, figure-eight-bandage in children over two years of age. Surgical treatment was open reduction of fragments and fixation with either a Kirschner wire or a titanium elastic nail (TEN); titanium plates were used in several cases. For a comparative assessment of the results of the treatment methods for clavicle fractures, two groups of patients were formed. Results Shortening of consolidated clavicle was not observed in children of the main group treated surgically. In several cases, the elongation of the clavicle was revealed by no more than 1 cm. Patients in the comparison group showed shortening of the broken clavicle in three cases, no more than 1.3 cm. Conclusion After surgical treatment, the length of the shoulder girdle was fully restored; insignificant shortening after conservative treatment did not cause functional disorders.

Diaphyseal Femur Fracture in Paediatric Age group: Outcome with fixation by Elastic Nailing System

Background: Diaphyseal femur fracture in paediatric age group account for 1.6% of all paediatric fractures. Fracture fixation by elastic nail provides three point fixation. This study aims to assess the outcome of diaphyseal femur fracture in paediatric age group from 5 to 15 years treated with titanium elastic nailing system.Methods: Thirty six patients with diaphyseal femur fracture were treated with titanium elastic nailing system from November 2018 to August 2020 was analyzed prospectively. All the patients were followed up for six months for the study. Final outcome was evaluated at six months.Results: The mean time of fracture union was 9.12 weeks. Two patients had limb lengthening of 6 mm and 8 mm respectively. One patient had 1 cm of shortening and 8 degree of varus angulation and 9 patients had bursitis over nail insertion site. According to Flynn grading 26 cases have excellent results (72.22%) and 10 cases have satisfactory results (27.78%).Conclusion: Diaphyseal femur fracture can be treated with elastic nailing system with early mobilization and good functional outcomes.Keywords: Diaphyseal femur fracture, Elastic nail, Fracture union, Titanium elastic nailing system

FAST- Fixator Assisted Submuscular plating Technique-A simplified technique of submuscular plating in paediatric femur fractures.

The surgical management of paediatric femur fractures has evolved over the last few decades. Intramedullary stabilization with titanium elastic nail (TENS) is the preferred surgical management for length stable and mid diaphyseal femur fractures in children between 5-11 years of age. However, TENS is not preferred in length unstable fractures and in proximal or distal metaphyseal femur fractures due to higher incidence of angulation and shortening at fracture site. In such scenarios, submuscular plating has come up as an alternative surgical treatment modality which avoids these complications and provide good functional outcome. Many authors have suggested different surgical variations in techniques of submuscular plating for paediatric femur fracture. We have devised a technique of submuscular plating with help of external fixator (FAST) in paediatric femur fractures which minimises the surgical time and simplifies the procedure.

Single versus dual elastic nails for closed reduction and antegrade intramedullary nailing of displaced fifth metacarpal neck fractures

Closed reduction and internal fixation with antegrade intramedullary nails is a feasible and effective treatment for displaced fifth metacarpal neck fractures (FMNFs). The present study aimed to compare clinical and radiological outcomes in patients with displaced FMNFs after treatment with single or dual antegrade elastic intramedullary nails (AEIMNs). Thirty-three patients were treated with a single 2.0 mm AEIMN and 34 patients were treated with two 1.5 mm AEIMNs. Clinical and radiological outcomes included grip strength, active range of motion (ROM), active flexion and extension of the fifth metacarpophalangeal (MCP) joint, dorsal angulation loss, and metacarpal shortening of the fifth metacarpal at 12 months after treatment. No significant difference was observed between the two groups with respect to grip strength, ROM or flexion of the fifth MCP joint. The average values of dorsal angulation loss, metacarpal shortening, and extension of the fifth MCP joint of the dual nails group were better than those of the single nail group (dorsal angulation loss, 2.79 ± 1.93° vs. 4.05 ± 1.59°, P = 0.009; metacarpal shortening, 1.66 ± 0.80 mm vs. 2.12 ± 0.88 mm, P = 0.028; extension of the fifth MCP joint, 7.71 ± 4.43° vs. 4.82 ± 4.09°, P = 0.012). In conclusion, dual AEIMNs fixation provided better MCP extension and radiological outcomes than single AEIMN fixation.

Comparison of three treatment methods for simple bone cyst in children

BackgroundThe unicameral bone cyst (UBC) is a kind of benign tumor whose clinical treatments and efficacy are controversial. The purpose of this study was to evaluate the efficacy of the elastic stable intramedullary nail (ESIN), the injection of autologous bone marrow (ABM), and the combination of ESIN and ABM in the treatment of bone cyst in children.MethodsEighty-three cases with simple bone cyst were analyzed retrospectively. Twenty-eight cases were treated with ABM. Twenty-eight cases were treated with ESIN. Twenty-seven cases were treated with ABM and ESIN. All cases were diagnosed through X-ray, CT, or MRI scans. For the suspicious ones, the pathological biopsy was performed for an accurate diagnosis. X-ray examinations were carried out for the postoperative follow-up. Capanna criteria for bone cyst was used for postoperative evaluation of three methods.ResultsAll cases accomplished the follow-up. The effective rate of the ABM + ESIN group was significantly higher than that of the ABM group (P < 0.05), and the cure rates of the ESIN group and the ABM + ESIN group were higher than that of the ABM group (P < 0.05, respectively). The cure time in the ESIN group was lower than that of the other two groups (P < 0.05, respectively). The times for admission were 2.0 ± 0.0 in the ESIN group, 5.7 ± 1.9 in the ABM group, and 4.7 ± 2.4 in the ABM + ESIN group (P < 0.05 when compared with each other).ConclusionsThe method of ABM combined with ESIN for children’s bone cyst has the highest effective rate and curative rate. For the individual method, ESIN has a higher effective rate and curative rate than that of ABM. Meanwhile, it has the fewest time of hospitalization.

Analysis of the Results of Titanium Elastic Nails (TENS) in Paediatric Femur Fractures

Analysis of the Results of Titanium Elastic Nails (TENS) in Paediatric Femur Fractures

Outcome of Elastic Stable Intramedullary Nailing (ESIN) for tibia fractures in children.

Objectives: To determine outcome in displaced tibial shaft fracture in children treated with elastic stable intra-medullary nailing. Study Design: Descriptive, Case Series study. Setting: Department of Orthopedic, Bahawal Victoria Hospital, Bahawalpur, HBS Medical &amp; Dental College, Islamabad and HITEC-IMS Taxila Cantt, Pakistan. Period: 2012 to 2019. Material &amp; Methods: A total of 62 cases of displaced tibial shaft fracture presenting within 7 days of the injury, 6 to 11 years of age of either gender were included. Patients with segmental tibial shaft fractures and open tibial shaft fractures, Gustilo Grade II &amp; III were excluded. The titanium elastic nails system (TENS) was used in all patients according to the departmental protocols. The sampling technique was consecutive with non-probability. All the patients were followed up in OPD at 2 weeks interval up to 24 weeks after surgery and union of fracture was recorded at 24th week. Results: Mean age was8.55 ± 1.77 years. Out of these 62 patients, 45 (72.58%) were male and 17 (27.42%) were females with ratio of 2.65:1. Mean duration of fracture was 3.10 ± 1.95 days. Mean duration of union in displaced tibial shaft fracture in children treated with elastic stable intra-medullary nailing was 19.40 ± 3.35 weeks. Conclusion: This study concluded that use of elastic stable intra-medullary nailing for displaced tibial shaft fracture in children leads to shorter duration of union reliably with minimal complications.

Results of flexible nails for fixation of tibial diaphysis fractures in children

Background: Fracture tibia is one of the most common fractures in the pediatric age group. It accounts about 15% of cases. In majority of cases, close reduction and plaster application is the mainstay of treatment. Objectives: The objective was to assess the outcome of flexible nails in the treatment of tibial diaphysis fractures in children and to evaluate the results regarding the union rate and complications including limb length discrepancy, angular deformities, and pain. Materials and Methods: This prospective descriptive case–control study which included 30 children with 30 unilateral tibial diaphysis fractures in which the physis were open, all were closed, and open (type 1 and type 2) fractures, and with displaced transverse, short oblique, and spiral fractures, in which the trial of close reduction was failed. All patients are admitted and operated at West Erbil Emergency Hospital. Alignment of fractures, any infection, delayed union, nonunion, limb length discrepancy, motion of knee joint, time of complete union, and skin irritation were assessed with minimum follow-up period of 6 months. Results: In the current study, the complete union was achieved in 9–11 weeks in 20 (66.7%) patients, while in 6 (20%) patients, achieved in 12 weeks, and in 4 (13.3) patients, achieved in 13–16 weeks that were regarded as a delayed union. In 6 (20%) patients, there were nail protrusion and skin irritation, no shortening more than 0.5 cm was recorded, shortening <0.5 cm recorded in 12 (40%) patients, and no lengthening was recorded. In 3 (10%) patients, the angulations in coronal and sagittal views were 5°–10°. There was no case of nonunion. Conclusion: Elastic nails are an effective way for the treatment of the pediatric tibial diaphysis fractures. It is a simple and easy method but with radiation risk, although elastic nails have complications, all are avoidable and minor that will be managed with minimal intervention.

The Bisaccia and Meccariello technique in pediatric femoral shaft fractures with intramedullary titanium nail osteosynthesis linked external-fixator (IOLE): validity and reliability.

Background:Over the last 20 years, the incidence of pediatric femoral shaft fractures was increased, due to changes in the children’s daily activities. The healing times are different according to the chosen treatment and to other factors such as age, type of fracture, the involvement of the soft tissues, and concomitance with other injuries. The Bisaccia and Meccariello technique (Intramedullary titanium nail Osteosynthesis Linked External-fixator -IOLE) was born to prevent rotationally and lengthening malunion or nonunion in the treatment of pediatric femoral shaft fractures.Hypotheis:The aim or the objective of this paper is to compare the IOLE with the two most used methods for the treatment of femoral fractures in children.Methods:From 2000 to 2016, 58 pediatric patients with femoral shaft fractures were surgically treated and enrolled in the study. The ranged age of the patients was between 3 and 15 years. Twenty-two patients were treated with endomedullary titanium nails (TEN), 22 with external axial or modular external fixators and 14 patients treated with IOLE technique. The IOLE technique, in brief, is the hybridization of titanium intramedullary nails with a modular external fixator. It is divided into three phases, the first revenue given the length of the femur with the external fixator; the second, the rotations are dominated by the elastic nails; and the third finally they are hybridized on the external fixator. Comparing the three groups, radiographic images were taken to assess fracture reduction and consolidation.Results:At the final follow-up, statistically significant differences in not weight-bearing times were found in favor of the IOLE group. There were no statistical differences between three groups in terms of significant rotation defects, angulation, growth, and/or nonunion.Conclusions:The Bisaccia- Meccariello technique (IOLE) showed to lead to healing the pediatric femoral shaft fracture of the femur but allows an early weight-bearing to these patients and normal life like that.

Role of mini-invasive bridge plate in the complex femoral fracture in school going children: A prospective clinical study of 30 cases.

Objective:Pediatric femoral fracture including supracondylar and subtrochanteric fracture constitutes 1.6% of all paediatric fracture. Elastic nails remain the standard treatment of choice in a midshaft transverse femoral fracture in children weighing less than 45 kg. But in subtrochanteric and spiral femoral fracture, the failure rate of elastic nails are quite high. Hence, in accordance with AAOS guidelines, we treated complex femoral fracture in children with submuscular mini-invasive bridge plate because of its advantage of minimal incision, early union with proper alignment and lower failure.Material and Methods:We retrospectively reviewed 30 complex femur fracture in children treated with Submuscular bridge plate by mini-invasive approach. Patients were analysed according to their age, type of fracture, time of union in weeks, complication and results were evaluated with modified Flynn's criteria.Result:Out of 30 patients 28 were boys and 2 were females, with an average age of 11.5 years in which Spiral fracture (n = 12), subtrochanteric fracture (n = 9), Complex Shaft fracture (n = 10). All fracture united well on an average of 11 weeks. And 29 patients has excellent results and in 1 patient there is Acceptable result. The single complication was 3 mm limb lengthening but it didn't change gait of the patient.Conclusion:Mini invasive bridge plating is an easy and soft tissue preserving procedure for managing complex femoral fracture in children. It has shown promising results in achieving union without any major complication. We strongly recommend the SBP in a complex femoral fracture in children.

Minimally invasive antegrade intramedullary fixation for unstable subcapital fracture of the fifth metacarpal by single elastic nail

Background Fractures of the neck of the fifth metacarpal are common and mainly occur in young men. The injury often occurs through aggression, such as a fist fight or punching a hard object. The aim of this study was to assess clinical and radiological outcomes of fifth metacarpal neck fractures using minimally invasive antegrade single intramedullary fixation prepending elastic nails in the selected patients and to explore the ideal puncture point to avoid iatrogenic ulnar nerve injury. Patients and methods A single elastic nail with suitable diameter was used in 24 cases of fifth metacarpal neck fractures with dorsal angulation over 45°. An initial entry point was perforated at the ulnar-dorsal base of the metacarpal. The nail was inserted in an antegrade approach. The nail was usually removed at about 8 weeks postoperatively. Results This study reported the results of 24 patients who were affected by closed fractures of the neck of the fifth metacarpal bone (boxer’s fracture) and were treated with percutaneous single elastic intramedullary nailing to verify the effectiveness of this surgical treatment. The average follow-up period was 20.75 months. The parameters evaluated included angulation, rotational alignment, postoperative metacarpophalangeal range of motion, and time to union. At the final follow-up, no patient reported residual pain, and all fractures proceeded to bony union. Conclusion The authors recommend that this percutaneous single elastic intramedullary nailing was a minimally invasive and reliable fixation technique for fifth metacarpal neck fractures with good functional results and low morbidity.

Surgical management of adolescent both bone forearm fractures using a plate and screws versus an intramedullary elastic nail

Surgical management of adolescent both bone forearm fractures using a plate and screws versus an intramedullary elastic nail

Functional outcome of displaced fracture middle third of clavicle managed surgically by titanium elastic nailing

Introduction: In the clavicle fractures, shaft fractures are very common constituting about 70-80% of cases followed by lateral end and medial end fractures of clavicle. Surgical management is better option in displaced midclavicular fractures considering high complication rates in conservative management. Materials and Methods: This was a prospective study conducted between August 2016 to February 2018 approved by ethical committee of our Institute. 28 midclavicular fractures were included in the study and were operated Titanium Elastic Nailing (TENS). All patients were assessed clinocoradiologically at 4, 8 12 and 24 weeks. The functional outcome was assessed by Constant and Murley score. Results: Time taken for radiological union was achieved with an average of 10.89±1.79 weeks. Functional assessment was made with Constant and Murley score at 24 weeks showed excellent score in 20 cases (71.4%), good score in 7 case (25%) and fair score in 1 case (3.6%). Only patient had complication, nail protrusion at posterior cortex of lateral end of clavicle was seen at 20 weeks. Conclusion: In closed mid-shaft clavicle fractures TENS nailing is good an option considering better functional outcome, faster union and fewer complication in properly selected cases.

A Clinical Study of Surgical Management of Clavicle Fracture with Titanium Elastic Nail

Background and Objectives: Clavicle fractures account for 3-5% of all fractures, of them 70-80% are middle shaft fractures. Conservative management was treatment of choice in past but due to increased fracture rates and dissatisfaction of patients due to nonoperative treatment; management of these fractures has shifted to operative one. Early complications are neurovascular bundle injury, skin laceration, bleeding. Late complications include malunion leading to shoulder shortening. Newer method for clavicle fracture is intramedullary nailing using Titanium elastic nails. TEN is flexible and assume s shape of clavicle and holds the fragments in-situ by 3 points fixation principle. It also prevents the rotation, angulation and shortening of fragments. Materials and Methods: A study of 30 cases was conducted at Department of Orthopedics, Rohilkhand Medical College Bareilly from November 2018 to November 2019. These patients operated with titanium elastic nail (TEN) with follow up for 6 months included. Results: Majority of patients in our study 13 patients (43.3%) were in the age group of 25-35 years. The average age was 38.7±11.4 yrs (range from 25 to 60). 23 patients were successfully treated with closed reduction and nail insertion while 7 patients had to undergo mini-open (minimal incision) for fracture reduction. Mean operative time was 23.5 minutes (15-38.5 minutes). Out of 30 patients 26(86.67%) had excellent outcome, 2(6.67%) had fair outcome, 1(3.34%) had good outcome and 1(3.34%) had poor outcome. Conclusion: The study shows that fixation of clavicular fractures with Titanium Elastic Nailing System (TENS) is easy to do procedure which gives faster pain relief, speedy functional recovery. Moreover, the Cosmetic problems due to post- operative scar and other postoperative complications are lower.

Evaluation and outcomes of surgical management of radius Sulna diaphyseal fracture using titanium elastic nailing system (TENS)

Introduction: Management of radius ulna diaphyseal fracture in the age group of 3–17 years. The purpose of this study is to demonstrate the effectiveness of intramedullary fixation of radius ulna shaft fractures by using titanium elastic nailing system (TENS). Materials and methods: 40 pediatric patients (31 boys, 9 girls) aged 3–17 years with diaphyseal radius ulna fractures were treated by TENS fixation. The final results were evaluated by using criteria. Results: 100% Pediatric patients had excellent to good results radiological results and 95% Pediatric patients had excellent to good functional results. Conclusion: TENS is a safe and effective method for the treatment of pediatric radius ulna shaft fractures, because it is minimally invasive, relatively easy to use and shows very good functional and cosmetic results.

Evaluation of diaphyseal femoral fractures in children treated with tens nailing: A clinical study

Femur fracture is very common fracture in children. Femur shaft fracture around 2% pediatrics age group fracture. Various methods are used to treatment in femur fracture. Like hip Spica, plating, nailing with tens or Enders nailing. Enders and tens are commonly used methods. Purpose of study: The know of outcome of elastic tens nailing in pediatrics shaft fracture. Material and Method: We study’s 24 children’s of fracture shaft of femur between age group 5 to 14. Result: The minimum fellow up to 8 month. The average time taken to full weight bearing and clinical union is 6 week to 8 week. In 3 cases there is superficial infection present in 2nd week of post-surgery. Which is cure by antibiotics and wound washing. No case of nonunion, out of 24 cases 12 cases have limb length discrepancy. 6 cases had lighting 6 cases had shorting. On the Flynn criteria 22 cases have excellent result 2 have satisfactory result. No cases show any unsatisfactory results. Conclusion: Cases which treated by tens elastic nailing achieved primary healing. The advantage of treating patient with enders nail had early weight bearing, reduced hospital stay, less bedridden and early to start to study. Overall tens elastic nailing is have many benefits either then conservation treatment.

Sub muscular bridge plating for pediatric femur fractures – Review of 12 patients

Introduction: The treatment of paediatric femoral fractures has been evolving from nonoperative modalities to operative intervention, especially in older children. Different methods of fixation include flexible intramedullary nailing, modified locked intramedullary nailing, external fixation, open compression plating, and sub muscular bridge plating. Treatment of complex paediatric femur diaphyseal fractures is difficult by conventional methods. External ?xation can lead to malalignment and refractures, casting is difficult for polytrauma patients and larger children, elastic nails do not provide adequate stability to unstable fractures and metaphyseal areas, and lateral trochanteric entry rigid nails are unsuitable for very proximal and distal fragments and are ideal for older children for the want of larger medullary canal. Sub muscular bridge plating has emerged as a viable alternative procedure. We present our results of sub muscular bridge plating in 12 patients. Materials and Methods: We retrospectively reviewed 12 patients with pediatric diaphyseal femoral fractures treated with SBP from 2014 to 2016. The average age was 9 years with follow up of 1yr. Results: All the children had complete union and could return to full activity. Two patients had superficial infections. There were no cases of significant malalignment or leg length discrepancy. Implant removal was performed in 8 patients without complications. Conclusion: We find sub muscular plating of paediatric femoral fractures to be an effective and reliable procedure. SBP is a minimally invasive technique that allows early mobilization with minimal complications. Keywords: Paediatric femur fractures, Submuscular plating.