A novel technique for pediatric femoral locked submuscular plate removal: the ‘push-pull’ technique

Submuscular and minimally invasive plate insertion is gaining popularity reducing the need for large open approaches and resulting in a smaller operative 'footprint.' With pediatric fractures and titanium implants, fibrous and osseous ingrowth to the implant and osseous implant integration may interfere with implant removal. Therefore, the small minimally invasive implant insertion procedure may require a large maximally invasive exposure for implant removal after fracture healing. To reduce soft tissue damage, bleeding, scarring, and pain associated with implant removal, a minimally invasive procedure utilizing the pre-existing incisions while controlling the implant is efficient and beneficial. The surgical technique is described, and a case series of 21 treated pediatric femoral fractures illustrates the successful performance of the procedure and its limitations.