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Burton MG, Bujnowski D, Smith PA. Growth Arrest in Type IV Osteogenesis Imperfecta After Fassier-Duval Rod Insertion Treated by a Lengthening Magnetic Intramedullary Nail: A Case Report. JBJS Case Connect 2023; 13:01709767-202312000-00009. [PMID: 37831805 DOI: 10.2106/jbjs.cc.23.00383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
Abstract
CASE A child with Type IV Osteogenesis Imperfecta (OI) sustained a growth arrest of the distal femur after fixation of a left femur fracture with a Fassier-Duval expanding rod at 3 years old. Despite bar resection with fat interposition, the discrepancy progressed to 7.5 cm at maturity. Because the femur had grown to a sufficient diameter, he underwent successful lengthening with a magnetic intramedullary rod. CONCLUSION Although it is a potential complication, growth arrest has not been reported in association with placement of an expanding nail in a child with osteogenesis imperfecta. This case illustrates this rare complication and treatment using a magnetic intramedullary rod.
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Affiliation(s)
- Michael G Burton
- Department of Orthopaedic Surgery, University of Illinois-Chicago, Chicago, Illinois
| | - Daniel Bujnowski
- Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
| | - Peter A Smith
- Shriners Children's Chicago, Chicago, Illinois
- Department of Orthopaedic Surgery Rush University, Chicago, IL
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Bacaksiz T, Akan I. Complications After Intramedullary Fixation Treatment of Patients With Osteogenesis Imperfecta: Telescopic Versus Non-Telescopic Implants. Cureus 2023; 15:e45376. [PMID: 37731684 PMCID: PMC10507367 DOI: 10.7759/cureus.45376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2023] [Indexed: 09/22/2023] Open
Abstract
Introduction The treatment of musculoskeletal pathologies in osteogenesis imperfecta aims to provide the maximum possible function by preventing bone fractures and progressive deformities. Despite the development of implants used in the surgical treatment of osteogenesis imperfecta, there is no consensus on the most appropriate method for the correction of skeletal deformities. The aim of this study was to compare telescopic and non-telescopic implants in terms of postoperative complications. Methods Twenty-three patients who were operated on for the diagnosis of osteogenesis imperfecta between 2005 and 2018 were retrospectively analyzed. Demographic data, follow-up times, and the total number of surgeries and complications were recorded. The operated bones were divided into two groups according to whether the intramedullary fixation material used was telescopic or not. Results Twenty-one of 23 patients were included in the study due to the use of intramedullary fixation material in the operation. The mean age was 10.1 ± 2.9 years, and the mean follow-up period was 8.9 ± 3.5 years. Intramedullary fixation was applied to 43 long bones in 21 patients due to fracture or deformity. At least one complication was encountered in nine of 14 bones with telescopic implants and in 27 of 29 bones with non-telescopic implants. Major complications requiring surgical treatment were seen in seven bones of the telescopic implant group and 27 bones of the non-telescopic implant group. Conclusion The use of telescopic implants relatively reduces the complication rate and the need for repetitive surgery in patients with a diagnosis of osteogenesis imperfecta. However, the number of complications is still as high as with non-telescopic implants.
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Affiliation(s)
- Tayfun Bacaksiz
- Department of Orthopedics and Traumatology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, TUR
| | - Ihsan Akan
- Department of Orthopedics and Traumatology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, TUR
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Rella RT, Brandon AS, Garrison IA, Young P, McDonald TC. A Fracture From a Physical Exam: A Case Report of Osteogenesis Imperfecta and the Use of Fassier-Duval Rods. Cureus 2023; 15:e37068. [PMID: 37153255 PMCID: PMC10155823 DOI: 10.7759/cureus.37068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2023] [Indexed: 04/05/2023] Open
Abstract
Osteogenesis Imperfecta (OI) is a rare hereditary disorder that leads to fragile bone mineralization and is most often due to a genetic defect in type I collagen, the primary collagen subtype that comprises bone. Patients with OI suffer from a significant burden of fractures and bony deformities. It has been recognized in countries throughout the world and has a variable age and severity of presentation depending on the subtype of OI. Recognition of this disorder requires a high index of suspicion on the part of the clinician, as it can easily be mistaken for non-accidental trauma in children. The current approach to care for patients with this disorder comprises surgical care with intramedullary rod fixation, cyclic bisphosphonate therapy, and rehabilitation to maximize the patient's quality of life and function. This case report demonstrates the importance of considering OI in the differential diagnosis of a child presenting with recurrent fractures so that appropriate testing and treatment interventions can be implemented. The case presented here is that of a male patient with osteogenesis imperfecta who suffered from recurrent long bone fractures, including his femurs bilaterally. His index fracture occurred after a visit to the pediatric ER for an unrelated issue, where his mother claimed that the boy demonstrated pain in his affected leg shortly after the visit. There was a delay in his diagnosis, and the patient suffered multiple fractures before undergoing the insertion of Fassier-Duval rods bilaterally into his femurs to prevent further injury.
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Hung YC, Cheng KY, Lin HY, Lin SP, Yang CY, Liu SC. Surgical Strategy to Decrease the Revision Rate of Fassier-Duval Nailing in the Lower Limbs of Osteogenesis Imperfecta. J Pers Med 2022; 12:jpm12071151. [PMID: 35887648 PMCID: PMC9323302 DOI: 10.3390/jpm12071151] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/05/2022] [Accepted: 07/12/2022] [Indexed: 11/30/2022] Open
Abstract
(1) Background: The Fassier−Duval (FD) nail was developed for the treatment of osteogenesis imperfecta (OI). The aim of this study was to review the results of OI patients treated with the FD nail at our institution and discuss a surgical strategy to decrease the FD nail revision rate; (2) Methods: We retrospectively reviewed OI patients treated at our institution between 2015 and 2020. OI patients treated with FD nail insertion in the long bones of the lower extremities were included, and those with a follow-up duration <1 year or incomplete radiographs were excluded. Data on the type of OI, age, sex, use of bisphosphonate treatment, and nail failure were recorded; (3) Results: The final cohort consisted of seven patients (three females and four males) with ten femurs and ten tibiae involved. Six of the patients had type III OI, and one had type IV OI. An exchange of implant was required in 11 limbs. The average interval between previous FD nail insertion and revision surgery was 2.4 years; (4) Discussion: The main reasons for revision surgery were migration of the male/female component, refracture/nail bending, and delayed union. In the femur, migration of the female component or nail bending were common reasons for failure, while migration of the male component and delayed union were common in the tibia; (5) Conclusions: Surgery for OI patients is challenging, and physicians should aim to minimize complications and the need for revision. Sufficient depth of purchase, center−center nail position, and adequate osteotomy to correct bowing are the key factors when using the FD nail.
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Affiliation(s)
- Yi-Chi Hung
- Department of Orthopedics, MacKay Memorial Hospital, Taipei 10449, Taiwan; (Y.-C.H.); (K.-Y.C.); (S.-C.L.)
| | - Kai-Yuan Cheng
- Department of Orthopedics, MacKay Memorial Hospital, Taipei 10449, Taiwan; (Y.-C.H.); (K.-Y.C.); (S.-C.L.)
| | - Hsiang-Yu Lin
- Department of Pediatrics, MacKay Memorial Hospital, Taipei 10449, Taiwan; (H.-Y.L.); (S.-P.L.)
- Department of Rare Disease Center, MacKay Memorial Hospital, Taipei 10449, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City 25245, Taiwan
- MacKay Junior College of Medicine, Nursing and Management, Taipei 11260, Taiwan
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung 406040, Taiwan
| | - Shuan-Pei Lin
- Department of Pediatrics, MacKay Memorial Hospital, Taipei 10449, Taiwan; (H.-Y.L.); (S.-P.L.)
- Department of Rare Disease Center, MacKay Memorial Hospital, Taipei 10449, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City 25245, Taiwan
- Department of Infant and Child Care, National Taipei University of Nursing and Health Sciences, Taipei 10650, Taiwan
| | - Chen-Yu Yang
- Department of Orthopedics, MacKay Memorial Hospital, Taipei 10449, Taiwan; (Y.-C.H.); (K.-Y.C.); (S.-C.L.)
- Correspondence:
| | - Shih-Chia Liu
- Department of Orthopedics, MacKay Memorial Hospital, Taipei 10449, Taiwan; (Y.-C.H.); (K.-Y.C.); (S.-C.L.)
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Mindler GT, Ganger R, Stauffer A, Marhofer P, Raimann A. [Osteogenesis imperfecta : A multidisciplinary challenge]. ORTHOPADIE (HEIDELBERG, GERMANY) 2022; 51:595-606. [PMID: 35776152 DOI: 10.1007/s00132-022-04260-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/11/2022] [Indexed: 06/15/2023]
Abstract
Osteogenesis imperfecta (OI) describes a group of rare diseases which are associated with an increased tendency to bone fractures. In addition to the main symptom of fractures, OI is characterized by a variety of pediatric, pediatric orthopedic and anesthesiological challenges. The multidisciplinary expertise is mostly concentrated at specialized centers. The current treatment concepts aim at minimizing the fracture rate, prevention and treatment of deformities, pain reduction and improved mobility. In addition to pharmacotherapy, conservative and surgical measures are also applied. Scheduled interventions on the extremities are one of the most commonly performed operations in children with OI. Various intramedullary nailing techniques are available. This article addresses the important aspects of multidisciplinary care of children with OI concerning the treatment of the lower extremities.
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Affiliation(s)
- Gabriel T Mindler
- Abteilung für Kinderorthopädie, Orthopädisches Spital Speising, Speisinger Str. 109, 1130, Wien, Österreich.
- Vienna Bone and Growth Center, Wien, Österreich.
| | - Rudolf Ganger
- Abteilung für Kinderorthopädie, Orthopädisches Spital Speising, Speisinger Str. 109, 1130, Wien, Österreich
- Vienna Bone and Growth Center, Wien, Österreich
| | - Alexandra Stauffer
- Abteilung für Kinderorthopädie, Orthopädisches Spital Speising, Speisinger Str. 109, 1130, Wien, Österreich
- Vienna Bone and Growth Center, Wien, Österreich
| | - Peter Marhofer
- Vienna Bone and Growth Center, Wien, Österreich
- Abteilung für Anästhesiologie und Intensivmedizin, Orthopädisches Spital Speising, Speisinger Str. 109, 1130, Wien, Österreich
| | - Adalbert Raimann
- Vienna Bone and Growth Center, Wien, Österreich
- Universitätsklinik für Kinder- und Jugendheilkunde, Abteilung für Pädiatrische Pulmologie, Allergologie und Endokrinologie, Medizinische Universität Wien, Spitalgasse 23, 1090, Wien, Österreich
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