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Modified Sofield-Millar operation: less invasive surgery of lower limbs in osteogenesis imperfecta
Mazen Abulsaad1, Ashraf Abdelrahman
1Orthopedic Department, Faculty of Medicine, Mansoura University Hospital, Mansoura, Egypt. mabulsaad@hotmail.com
Abstract:
We present the results of intramedullary rodding of long bones of the lower limbs in children with osteogenesis imperfecta using a modified Sofield-Millar operation. Fourteen patients (mean age at primary operation was 5 years 11 months) were treated with a modified Sofield-Millar operation which allows minimal bone exposure, preservation of the periosteum and keeping the number of osteotomies to the minimum. Union was achieved in all cases within 7 weeks. Of the 14 patients (29 bones) treated with nonelongating rods, rod revisions were needed in 13 patients (26 bones). We found no statistically significant difference between the width of the bone immediately postoperatively and at the final follow-up. The walking ability was improved in four patients. Advantages of less invasive surgery in osteogenesis imperfecta are rapid bone union, no bone atrophy or nonunion, better postoperative mobility and small scars.
Insights
This study on osteogenesis imperfecta (OI) found that a modified Sofield-Millar intramedullary rodding technique achieved rapid bone union in children. While rod revisions were common, the surgery offered benefits like improved mobility and minimal scarring.
Area of Science:
- Pediatric Orthopedics
- Skeletal Dysplasias
Background:
- Osteogenesis imperfecta (OI) is a genetic disorder characterized by fragile bones.
- Intramedullary rodding is a surgical technique used to stabilize long bones in children with OI.
Purpose of the Study:
- To evaluate the outcomes of a modified Sofield-Millar intramedullary rodding procedure in pediatric patients with osteogenesis imperfecta.
- To assess the efficacy of this minimally invasive approach in promoting bone union and improving functional mobility.
Main Methods:
- A modified Sofield-Millar operation was performed on 14 pediatric patients (mean age 5 years 11 months) with osteogenesis imperfecta.
- The surgical technique focused on minimal bone exposure, periosteal preservation, and reduced osteotomies.
- Non-elongating rods were used for intramedullary fixation of lower limb long bones.
Main Results:
- Complete bone union was achieved in all 14 patients within 7 weeks.
- Rod revisions were required in 13 patients (26 out of 29 bones) treated with non-elongating rods.
- No statistically significant difference was observed in bone width between immediate postoperative measurements and final follow-up.
- Improved walking ability was noted in four patients.
Conclusions:
- The modified Sofield-Millar operation facilitates rapid bone union in osteogenesis imperfecta.
- While rod revisions may be necessary, this less invasive surgical approach offers advantages such as preserved bone width, enhanced postoperative mobility, and reduced scarring.
