Evolution of metal constructs in orthopedic surgery of osteogenesis imperfecta
Objective: To improve outcomes of surgical treatment of bone deformities in children with osteogenesis imperfecta. Methods: At the Department of Traumatology and Orthopedics for Childhood of the SI «ITO NAMSU» treated 11 patients with osteogenesis imperfecta. We performed 23 surgeries with the use of intramedullary «growing» telescopic constructs to correct thighs and shin deformities. Results: In 9 patients for the correction of axial deformities of the lower limbs we used for osteosynthesis «growing» telescopic constructs. Their advantage is as follows: prevention of repeated fractures and bone deformities, and their disadvantages are as follows: danger of the rotational displacement for bone fragments and their displacement in length as well as inability to create compression in the osteotomy region. In this regard, in 2 patients we used an improved surgical procedure. On the first stage we performed corrective osteotomy and intramedullary nailing with locking rod and the distal part of the T-shaped telescopic component; on the second one locking screws were removed and construction was transferred into the «growing» kind after fusion of the fragments. In all cases fusion was obtained in due course. There was no violation of bone growth in length, repeated fractures and deformities. In one patient fixateur was replaced due to the divergence of its elements, in one more patient fixed bone pseudosarkoma ostoperatively. Conclusion: an improved method for the surgical treatment of bone deformities using intramedullary telescopic construct which is based on association of the principles of blocking compressive osteosynthesis and intramedullary osteosynthesis with «growing» telescopic rod is effective in cases of osteogenesis imperfecta and is accompanied by a low complication rate.
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