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Case Reports
. 2015 Oct-Dec;8(4):563-5.

Osteosynthesis in Osteogenesis Imperfecta, telescopic versus non-telescopic nailing

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Case Reports

Osteosynthesis in Osteogenesis Imperfecta, telescopic versus non-telescopic nailing

A Sterian et al. J Med Life. 2015 Oct-Dec.

Abstract

The paper refers to a pediatric patient suffering from Osteogenesis Imperfecta that was diagnosed soon after birth, after suffering from an intrauterine fracture of the femur in the 7th month of pregnancy. The beginning of the presentation contains some general considerations regarding the illness and the treatment done up to the point when the first telescopic rod was used. Following the evolution of the child from birth to the age of 7 years, we could trace a line of evolution under several methods of treatment, surgical or conservative, and also on different surgical treatment variants and their outcome during growth. Together with the X-rays that documented each step of the treatment, we could affirm for sure that both clinically and radiologically, the best results were obtained after the last 4 interventions, when all 4 major bones of the lower limbs were operated on. Until the moment Fassier-Duval nails were used, the evolution of the illness and the complications that appeared after certain surgery procedures were not so good. Several procedures had to be revised because of nail or pin displacement and eventually the patient lost the walking capability. The main problem with non telescopic treatment was the lack of stability that the bone needed to have after an open surgery for deformity correction, and up to that moment, the methods used were not designed to work on the long term; even in the best circumstances, the patient had to go to the OR for nail replacement after the bone outgrew it.

Keywords: Fassier–Duval nails; Osteogenesis Imperfecta; Osteosynthesis; telescopic versus non-telescopic nailing.

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Figures

Fig. 1
Fig. 1
X-ray showing severe bowing of both tibias (approx. 300). Left tibia has a displaced diaphyseal fracture produced while walking
Fig. 2
Fig. 2
Kirschner wire migrating through distal cortical wall in a femur. Secondary bowing of the bone marginal to the distal end of the wire
Fig. 3
Fig. 3
Severe bowing of the lower extremities. Both femurs have near 900 angulation after several fractures treated by cast immobilization. Right tibia fracture with displacement. Left tibia and peroneum fractures badly consolidated at 900 after a poor orthopaedic management
Fig. 4
Fig. 4
Postoperative image showing Fassier-Duval telescopic rod and corective osteotomies of the tibia
Fig. 5
Fig. 5
Late post surgery image of the same tibia with good bone healing, no component migration, and good bone alignment
Fig. 6
Fig. 6
Femur corective osteotomies and Kirschner wire ostesinthesys. Note the proximal displacement of the wire and iminent loss of stabilitiy

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