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. Jul-Aug 2019;53(4):554-559.
doi: 10.4103/ortho.IJOrtho_202_18.

Results of Rodding and Impact on Ambulation and Refracture in Osteogenesis Imperfecta: Study of 21 Children

Free PMC article

Results of Rodding and Impact on Ambulation and Refracture in Osteogenesis Imperfecta: Study of 21 Children

Atul R Bhaskar et al. Indian J Orthop. .
Free PMC article


Introduction: Delay in presentation and surgical intervention is quite usual in osteogenesis imperfecta (OI) because of various local and cultural beliefs. The purpose of this study is to review the results of 21 children who had intramedullary rodding and its effect on ambulation and refracture.

Methods: We reviewed 21 children with a clinical diagnosis of OI. The mean age of children at presentation was 8.74 years (3-21 years). All children had recurrent fractures of long bones. Twenty eight femurs and 21 tibiae were stabilized with intramedullary rodding. Ambulatory status was assessed by the Hoffers and Bullock's (H and B) grading, and muscle power was recorded using the Medical Research Council, U. K., grade. Ten children had received intravenous bisphosphonates preoperatively. Postoperatively, the children were assessed for ambulatory status, pain, and ability for independent self-care.

Results: The mean followup period was 34 months (24-48 months). Rush rods were used in 20 femurs, the Fassier-Duval (FD) rods in 6 femurs, and in two cases, with narrow intramedullary canals, Kirshner (K) wires were used. For the tibiae, 15 children received rush rods and in 6 cases, an FD rod was used. The mean time to fracture union was 8 weeks (6-12 weeks). Before surgery, 13 children were in H and B Grade 4 (wheel-chair independent or carried by parents usually in a developing country), four were able to ambulate with a walking aid (H and B Grade 3b), and four children were able to walk about in the house without aids (H & B Grade 2). After the rodding procedure, the ambulatoty status improved in 11 (50%) children. Seven children (33%) became household physiologic walkers (H & B Grade 3b), three achieved independent ambulation with orthosis (H & B Grade 1b), and one child with mild OI could walk unaided (H & B Grade 1a). No child had deterioration in ambulatory status. Only two children had refractures at the distal end of the rod due to continual growth of bones.

Conclusions: Intramedullary rodding treatment for recurrent fractures in children with OI improves their mobility potential. It also and prevents repeated cast application, disuse wasting, and osteopenia which can lead to deterioration in the quality of the long bones.

Keywords: Ambulation and rodding; osteogenesis imperfecta; refracture.

Conflict of interest statement

There are no conflicts of interest.


Figure 1
Figure 1
(a) A 12-year-old girl, H and B Grade IIIB, physiologic ambulatory, (b) bilateral femur fracture with deformity, (c) multiple scars of previous surgery: plating and “K” wire fixation done, (d) bilateral rush rod stabilization, (e) achieved community ambulation with orthosis (H and B Grade IB)
Figure 2
Figure 2
(a) A 7-year-old boy, H and B Grade IIIB, sustained pathological fracture of both femurs, (b) child underwent plating of both femurs, (c) child had fractured below the plate and underwent Fassier-Duval rodding. Achieved Grade IB ambulation
Figure 3
Figure 3
(a) A 9-year-old boy, H and B Grade IV, had received five cycles of bisphosphonates, (b) very narrow canal 2-mm k wires inserted, (c) Bilateral K wires inserted after multiple osteotomies, (d) achieved community ambulation with orthosis

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