الفهرس 
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Abstract
SUMMARY
Pediatric femoral shaft fractures are the most common pediatric fractures necessitating hospitalization and are associated with prolonged hospitalstayandprolongedimmobilization.Theyaffectmainlypreschool children and adolescents. They are most commonly caused by fall from height and road traffic accidents (RTA).
Femoralshaftfractures arehardtomissonexamination;deformity, swelling, shortening, tenderness, abnormal mobility, and inability to bear weight suggest the diagnosis. AP and lateral radiographs including both hips and knees confirm the diagnosis.
The treatment of pediatric femoral fractures is age dependent as fractures in children below 6 years of age are usually managed non- operatively due to the excellent remodeling potential of this age group, however treatment of these fractures in the age group from 6 to 12 yearsis still controversial with different methods of fixation including; flexible intramedullary nailing, modified locked intramedullary nailing, external fixation, open compression plating, and sub muscular bridge plating.
Currently submuscular bridge plating has evolved into an effective treatment option for the management of pediatric femur fractures.
Submuscular bridge plating is a minimally invasive technique that provides relative stability to the fractured diaphysis while maintaining length and angulation. There is minimal disruption of fracture hematoma and minimal amount of estimated blood loss. It avoids the growth plates and does not disrupt the blood supply to the femoral head. This technique potentially avoids the complications associated with the other surgical method sof treatment ,such as the sub optimal stability with titanium
elastic nails in length-unstable fractures, the re-fracture rate and pin site infectionswithexternalfixation,thewoundcomplicationsaswellasnon- union rates and need for blood transfusion due to intraoperative bleeding with traditional compression plating as well as the potential for avascular necrosis with the piriformis-entry intramedullary rigid nail.
This study was conducted to evaluate the results of fixation of the pediatric femoral fractures using submuscular bridge plating in 60patientspresentedto Beni-Suef UniversityHospital in theperiod between February 2020 and February 2021.
The study included 60 patients 21 were females, 39 were males with a mean age of 9.35 year ranges from (6-12 years), left side was affected in 33 patients (55%) and right side was affected in 27 patients (45%). That the fracture was located in the middle 1/3 in 36 cases (60%), proximal 1/3 in 15 cases (25%) and the fracture was located in the distal 1/3 in 9 case (15%). All patients had no intraoperative complications.
Postoperative complications occurred in three patients only; one patient (1.7%) had surgical site infection , one patient (1.7%) had limited range of knee motion of 10 degrees and one patient (1.7%) had limb length discrepancy of 1 cm which was not clinically significant. Other than that all patients had radiological union within a mean time of 7.30 weeks (6-12 weeks). All patients achieved full weight bearing within a mean time of 9 weeks (8-14 weeks). There were no residual frontal plane or sagittal plane deformities, no patients with clinically evident malrotation by the 24 weeks. There were No patients with delayed union or non-union.
Submascularbridgingplateinpediatricfemurfracturesisareliable method of fixation with excellent healing potential and minimal amount of complications. It can be used in both length stable and unstable fractures regardless the patient’s weight. It has advantages over the other methods of fixation. However it requires a high learning curve, more intraoperative time and more intraoperative exposure to fluoroscopy.