Pediatric Proximal Femoral Fracture Fixation Using 3.5 mm T-Plate: Outcomes

Overview

This prospective study evaluated 37 children aged 6 to 12 years with proximal femoral fractures treated by internal fixation using a 3.5 mm T-plate. The study assessed functional and radiographic outcomes, focusing on complication rates such as avascular necrosis (AVN).

Background

Proximal femoral fractures in children are rare but carry a high risk of complications, notably AVN of the femoral head. The Delbet classification categorizes these fractures by location, with type II being most common. Surgical fixation is preferred to minimize poor outcomes, with various implants available. This study investigates the efficacy of a small fragment 3.5 mm T-plate for internal fixation in this population.

Data Highlights

The study included 37 pediatric patients aged 6-12 years with Delbet type II, III, IV, and Azouz type V proximal femoral fractures treated within 24 hours of injury. Surgical fixation was performed using a contoured 3.5 mm T-plate with partially threaded 4 mm cancellous screws. Postoperative immobilization involved hip spica for children under 7 years and hip abduction braces for older children, with non-weight-bearing status maintained for 6 weeks.

Key Findings

• Proximal femoral fractures in children have an incidence of approximately 0.45 per 100,000 and represent about 1% of pediatric fractures.
• Delbet type II fractures are the most common, followed by types III and IV; type I fractures are rare but have the highest AVN risk.
• AVN occurs in about 29% of cases, typically manifesting 9–13 months post-injury, with initial displacement and fracture type as key predictors.
• Internal fixation with a 3.5 mm T-plate allows anatomical reduction and stable fixation tailored to the variable neck-shaft angles in children.
• Use of a contoured T-plate and partially threaded screws enables compression without damaging the femoral head growth plate.
• Postoperative protocols including immobilization and non-weight-bearing status are critical to optimize healing and reduce complications.

Clinical Implications

The 3.5 mm T-plate is an effective fixation device for pediatric proximal femoral fractures, allowing precise anatomical reduction and stable fixation while minimizing growth plate injury. Early surgical intervention within 24 hours and appropriate postoperative immobilization are essential to reduce complication rates such as AVN. Surgeons should contour the plate to the patient’s neck-shaft angle to optimize screw placement and fracture stability.

Conclusion

Internal fixation of pediatric proximal femoral fractures using a 3.5 mm T-plate yields favorable functional and radiographic outcomes with manageable complication rates. This technique represents a reliable surgical option in the skeletally immature population.

References

1. Azouz et al. 1993 -- Proximal Femoral Fractures Classification
2. Ratliff 1962 -- Avascular Necrosis Classification
3. Song et al. 2008 -- Criteria for Anatomical Reduction