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Published on: July 4, 2017
[Intramedullary Elastic Transphyseal Tibial Osteosynthesis and Its Effect on Segmental Growth]
Insights
Intramedullary transphyseal elastic osteosynthesis retards longitudinal bone growth in children, particularly in osteogenesis imperfecta cases. Proper rod placement is crucial to prevent angular deformities in the tibia.
Area of Science:
- Pediatric Orthopedics
- Biomaterials Engineering
- Skeletal Biology
Background:
- Intramedullary transphyseal elastic osteosynthesis is utilized for pediatric conditions with weakened bone tissue, such as osteogenesis imperfecta.
- This technique involves inserting elastic rods across growth plates to stabilize bones.
Purpose of the Study:
- To evaluate the impact of transphyseal elastic rod insertion on tibial growth in a pediatric model.
- To investigate the effects of combining transphyseal reinforcement with transverse fracture modeling and subperiosteal titanium mesh placement.
Main Methods:
- A non-randomized controlled study was conducted on 18 puppies, divided into three experimental series.
- Series I: Counter-directed transphyseal tibial reinforcement.
- Series II: Transphyseal reinforcement with transverse osteotomy.
- Series III: Transphyseal elastic osteosynthesis combined with subperiosteal titanium mesh and elastic rods during transverse osteotomy.
Main Results:
- Transphyseal reinforcement led to significant growth retardation in the operated tibia across all series (3.8-7.8 mm loss).
- Eccentric rod placement resulted in angular deformities of the distal tibial epiphysis (mean 7°).
- Periosteal and endosteal reactions caused diaphyseal diameter enlargement in Series II and III, but not in Series I.
Conclusions:
- Intramedullary transphyseal reinforcement retards longitudinal bone growth.
- Precise placement of elastic rods near the center of growth plates is essential to avoid angular deformities.
- Subperiosteal reinforcement does not impede fragment consolidation and can be integrated with transphyseal osteosynthesis.
Background:
Intramedullary transphyseal elastic osteosynthesis is used in children for the diseases accompanied by the reduced strength properties of bone tissue, and primarily for osteogenesis imperfecta.
Objective:
The purpose of the experimental study was to investigate tibial growth under the conditions of transphyseal counter-directed insertion of elastic rods without bone integrity breaking, under transverse fracture modeling, as well as under combining transphyseal reinforcement and subperiosteal positioning the titanium mesh with the elastic rods intervolved in it.
Methods:
Non-randomized controlled trial was performed. Three series of experiments performed in 18 puppies. Counter-directed transphyseal reinforcement of tibia performed in Series I, transphyseal reinforcement combined with transverse osteotomy of leg bones--in Series II, transphyseal elastic osteosynthesis and subperiosteal positioning the titanium nickelide mesh with intervolved in it elastic rods during transverse leg bone osteotomy performed in Series III.
Results:
Transphyseal reinforcement resulted in growth retardation of the operated tibia. The loss of residual growth was 3.8 mm (p=0.078) in series I; 7.8 mm (p=0.032)--in series II; 7.7 mm (p=0.042)--in series III. Eccentric insertion of transphyseal rods formed an angular deformity (mean value 7°; p=0.023) of the distal tibial epiphysis in the process of residual growth. Periosteal and endosteal reactions contributed to enlargement of diaphyseal diameter of 3.9 mm (series II; p=0.037) and 3.8 mm (series III; p=0.041). Any difference of diameter between operated and intact tibia was not observed in series I.
Conclusion:
Intramedullary transphyseal reinforcement retards longitudinal bone growth. The positioning of the telescopic systems should be as close as possible to the center of growth plates in order to prevent angular deformities. Subperiosteal reinforcement doesn't retard consolidation of fragments, and it can be combined with intramedullary transnhyseal osteosynthesis.
