Outcomes of internal fixation for pediatric proximal femoral fractures using a 3.5 mm T-plate
By
Abulsoud, Mohamed I.
Hussiny, Mohamed G.
Nematallah, Samir A.
Al Nahhas, Mohammed
Elsebaey, Ibrahim M.
Zayed, Emad
Elhalawany, Mohamed F.
Elgahel, Mostafa M.
Hassanein, Yahia A .
Shaheen, Elsayed
Abdou, Mohamed H.
Hassan, Mahmoud M.
March 6, 2026
Clinical Scorecard: Results of Pediatric Proximal Femoral Fracture Management with 3.5 mm T-Plate Internal Fixation
At a Glance
Category Detail
Condition Proximal femoral fractures in children Key Mechanisms Traumatic fractures classified by Delbet and Azouz systems; risk of avascular necrosis (AVN) related to fracture type and displacement Target Population Children aged 6 to 12 years with isolated, recent proximal femoral fractures (Delbet types II, III, IV and Azouz type V) Care Setting Orthopaedic surgical care with internal fixation using 3.5 mm T-plate
Key Highlights
Proximal femoral fractures are rare but have high complication rates, especially AVN (~29%) Surgical fixation with 3.5 mm T-plate aims to improve functional and radiographic outcomes Early surgery within 24 hours with anatomical reduction and implant contouring to patient anatomy is critical Guideline-Based Recommendations
Diagnosis
Use Delbet classification to categorize fracture type (I to IV) and Azouz addition (type V) Assess fracture displacement and patient age to predict AVN risk Exclude pathological, open, stress fractures, and polytrauma cases Management
Surgical fixation recommended for children >2 years with complete fractures Use 3.5 mm T-plate contoured to neck-shaft angle for internal fixation Perform open reduction if closed reduction fails after three attempts Administer first-generation cephalosporin prophylactically at induction Use hip spica for children <7 years and hip abduction brace for older children postoperatively Maintain non-weight-bearing status for 6 weeks post-surgery Monitoring & Follow-up
Follow-up with radiographs to assess fracture healing and implant position Monitor for signs of AVN typically presenting 9–13 months post-injury Evaluate functional outcomes regularly Risks
High risk of avascular necrosis, especially with proximal (type I) fractures and initial displacement Potential for non-union and coxa vara if inadequately treated Loss of reduction common with non-operative treatment in complete fractures Patient & Prescribing Data
Children aged 6 to 12 years with traumatic proximal femoral fractures
3.5 mm T-plate internal fixation is hypothesized to be effective, with surgical timing within 24 hours and anatomical reduction critical to outcomes
Clinical Best Practices
Perform surgery within 24 hours of injury to optimize outcomes Ensure anatomical reduction using Song’s criteria before fixation Contour the T-plate to match individual neck-shaft angle for optimal screw placement Use partially threaded 4 mm cancellous screws to achieve compression without damaging growth plate Employ appropriate postoperative immobilization based on patient age Maintain non-weight-bearing status for 6 weeks postoperatively References
