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Experience with Bailey-Dubow rodding in children with osteogenesis imperfecta
A Karbowski1, M Schwitalle, R Brenner
1Orthopaedic Department, Krankenhaus der Augustinerinnen, Cologne, Germany.
Aim:
The current report presents our experience with the use of Bailey-Dubow elongation rods in children with osteogenesis imperfecta.
Material And Methods:
63 patients with osteogenesis imperfecta underwent a total of 186 primary intramedullary fixations with Bailey-Dubow rods during period 1984-1996. Most of them were inserted into the femur (54.3 %), followed by the tibia (38.2%) and the humerus (7.9%). Patients' age at operation ranged from 1-12 years and treatment-period varied from 1-10 years.
Results:
Insertion into the femur showed the lowest complication rate (21.0%). Patients either suffered from knee-joint migration of the distal nail (3.9%), proximal nail migration (7.9%), detached T-pieces from the sleeve (7.9%) or chronical nail infection (1.0%). Complication rate after tibia rodding was markedly higher (52.1%). Knee joint migration appeared in 8.5% and the distal piece of the rod migrated proximally in 38.0%, in 31.0% accompanied by recurrent antecurve deformity. Growth arrest and no elongation occurred in 5.6%. Results after humerus operation were by far least satisfying. None of the nails elongated adequately. 8 of the 14 Bailey-Dubow rods (57.1 %) required reoperation caused by migration and chronic nail infection, whereas reoperation rates amounted to 17.8% after femur and 29.6% after tibia insertion. However, just one refracture happened after adequate trauma (road accident), so that an extraordinary success of fracture prevention has to be scored.
Conclusions:
We concluded that the use of Bailey-Dubow rods in early childhood can be recommended for the femur, whereas insertion into the tibia or humerus is associated with a considerable complication rate.
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