Сomplications in using different types of intramedullar telescopic fixators in children with osteogenesis imperfecta

Sergey Khmyzov, Andrey Pashenko

Abstract


Treatment of patients with osteogenesis imperfecta (OI) is a com­plex problem in orthopedics. The most effective method of surgi­cal correction of long bone deformities in OI is the use of Fassi­er-Duval rod. However, a significant number (35 %) of its as­sociated complications (instability, migration and lock eruption, no extension during bone growth, bone deformity and fractures in terms of loading, bone fractures) leads to development of the new approaches. In Sytenko Institute of Spine and Joint Pathol­ogy designed intramedullary telescopic fiction device (ITF), which combines the principles of rotational and axial stability.

Objective:to analyze the complications of treatment in OI chil­dren after fixation of long bones by means of rotary ITF stability and without it. Methods: we performed 28 surgeries in 9 patients with combined deformations of the bones of the lower limbs, us­ing ITF (5 rotary unstable, made of stainless steel and 23 rotary-stable — rods in 2 cases made of stainless steel, 21 — with tita­nium alloy).

Results: after the use of rotary unstable ITF, eternal immobilization was longer for 10– 14 days, and recovery time range of motion in adjacent joints were longer by 7 days on av­erage compared with the group of patients who used stable rota­ry ITF. There was the following symptoms: violation of blocking wires, deformation and limb segment with ITF migration, ab­sence of ITF lengthening, limb fracture with ITF. Complications from the use of rotary unstable ITF was 60 %, and after rotary-stable — 17.4 %.

Conclusions:the use of rotary stable ITF cor­recting deformities of long bones of the extremities in patients with OI is more efficient and leads to less (17.4 %) complica­tions.

Keywords


combined deformation; lower limb; intramed¬ullary telescopic rod; osteogenesis imperfecta; complications

References


Esposito PW, Turman K, Scherl S, et al. Simultaneous surgical treatment of multiple lower extremity deformities in children with osteogenesis imperfect [Online]: presented at the POSNA Annual Meeting (San Diego, CA May 2 to 6 2006). Available from: http://n-med.com.pl/folders/ Pega_article_8.pdf.

Ruck J, Dahan-Oliel N, Montpetit K, Rauch F, Fassier F. Fassier-Duval femoral rodding in children with osteogenesis imperfecta receiving bisphosphonates: functional outcomes at one year. J Child. Orthop. 2011;5(3):217–24. doi: 10.1007/s11832-011-0341-7.

Birke O, Davies N, Latimer M, Little DG, Bellemore M. Experience with the Fassier-Duval telescopic rod: first 24 consecutive cases with a minimum of 1-year follow-up. J Pediatr Orthop. 2011;31(4):458–64. doi: 10.1097/BPO.0b013e31821bfb50.

Cho TJ, Kim JB, Lee JW, Lee K, Park MS, Yoo WJ, Chung CY, Choi IH. Fracture in long bones stabilised by telescopic intramedullary rods in patients with osteogenesis imperfect. J Bone Joint Surg Br. 2011;93(5):634–8. doi: 10.1302/0301-620X.93B5.25499.

Ruck J, Dahan-Oliel N, Montpetit K, Rauch F, Fassier F. Fassier-Duval femoral rodding in children with osteogenesisimperfecta receiving bisphosphonates: functional outcomes at one year. J Child Orthop. 2011;5(3):217–24. doi: 10.1007/s11832-011-0341-7.

Birke O, Davies N, Latimer M, Little DG, Bellemore M. Experience with the Fassier-Duval telescopic rod: first 24 consecutive cases with a minimum of 1-year follow-up. J Pediatr Orthop. 2011;31(4):458–64. doi: 10.1097/BPO.0b013e31821bfb50.

Balanescu R, Ulici A, Rosca D, Topor L, Barbu M. Use of minimally invasive (percutaneous) Fassier-Duval telescopic rod on an 8 year old patient with Lobstein disease. Chirurgia. 2013;108(1):120–5.

Porat S, Heller E, Seidman DS, Meyer S. Functional results of operations in osteogenesisimperfecta: elongating and non-elongating rods. J Pediatr Orthop. 1991;11:200–3.

Zyma AM. The thesis for the degree of Doctor of Medicine «Structural and functional status of bone and osteogenesis imperfecta orthopedic treatment». Kiev, 2015. 289 p. (in Ukrainian)

Fassier F, Duval P, Dujovne A; Pega Medical. Intamedullary nail system.Patent US06524213 B1, A61B17/72. No US 09/671,164; 28.09.2000; 25.02.2003

Lang-Stevenson Al, Sharrard JW. Intramedullary rodding with Bailey-Dubow extensible rods in osteogenesis imperfecta: an interim report of results and complications. J Bone Joint Surg Br. 1984;66-B:227–32.

Jerosch J, Mazzotti I, Tomasevic M. Complications after treatment of patients with osteogenesis imperfecta with a Bailey-Dubow rod. Arch Orthop Trauma Surg. 1998;117(4–5):240–5.

Stockley I, Bell MJ, Sharrard WJ. The role of expanding intramedullary. J Bone Joint Surg Br. 1989;71(3):422–7.

Cho TJ, Choi IH, Chung CY, Yoo WJ, Lee KS, Lee DY. Interlocking telescopic rod for patients with osteogenesis imperfecta. J Bone Joint Surg Am. 2007;89(5):1028–35. doi: 10.2106/JBJS.F.00814

Porat S, Heller E, Seidman DS, Meyer S. Functional results of operation in osteogenesis imperfecta: elongating and nonelongating rods. J Pediatr Orthop. 1991;11(2):200–3.

Wilkinson JM, Scott BW, Clarke AM, Bell MJ. Surgical stabilisation of the lower limb in osteogenesisimperfecta using the Sheffield telescopic intramedullary rod system. J Bone Joint Surg. Br. 1998;80-B:999–1004.

Escribano-Rey RJ, Duart-Clemente J, Martínez de la Llana O, Beguiristáin Gúrpide JL. Osteogenesis imperfecta: treatment and results of a case series. Rev Esp Cir Ortop Traumatol. 2014;58(2):114–9. doi: 10.1016/j.recot.2013.11.007.

Alzahrani MM, Fassier F, Hamdy RC. Use of the Fassier-Duval telescopic rod for the management of congenital pseudarthrosis of the tibia. J Limb Lengthen Reconstr. 2016;2(1):23–8. doi: 10.4103/2455-3719.182572.

Monti E, Mottes M, Fraschini P, Brunelli P, Forlino A, Venturi G, Doro F, Perlini S, Cavarzere P, Antoniazzi F. Current and emerging treatments for the management of osteogenesis imperfect. Ther Clin Risk Manag. 2010;6:367–81.

Sofield HA, Millar EA. Fragmentation, realignment, and intramedullary rod fixation of deformities of the long bones in children. Ten years appraisal. J Bone Joint Surg Am. 1959;41(8):1371–91.

Popkov D, Kononovich N, Shutov R, Barbier D. Influence of the transphyseal sliding nailing on longitudinal growth of the tibia: Experimental studies [Online]. Available from : https: // www.researchgate.net/publication/281639668.

Коrzh МО, Khmizov SО, Коvaliov АМ, еt al.; SI «Institute of Spine and Joint Pathology prof. M.I. Sitenko NAMS of Ukraine». Іntramedullary telescopic fixator. Pat. 88254 UA. А61В 17/72. No u201310618; 02.09.2013; 11.03.2014; Bul. No 15.

Khmyzov SA, Pashenko AV. The use of intramedullary telescopic nails for osteosynthesis of long bones of the lower limbs in children with osteogenesis imperfecta. Orthopedics, Traumatology and Prosthetics. 2015;(2):13-8. doi: 10.15674/0030-59872015213-18.




DOI: https://doi.org/10.15674/0030-59872016462-67

Refbacks

  • There are currently no refbacks.


Copyright (c) 2017 Sergey Khmyzov, Andrey Pashenko

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.