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Outcomes of Telescopic Nailing of Lower Limb Deformities and Fractures in Children with Osteogenesis Imperfecta: A
Yasser Ahmed Othman Sorour1, Marwan Shams1, Abdelmageed Aboelabbas Abdelmageed Wahaballah1
1Orthopedic Sohag University.
Insights
Fassier-Duval telescopic nailing effectively treats lower limb deformities in children with Osteogenesis Imperfecta, showing significant functional and radiological improvements. This surgical method offers better mobility with an acceptable complication rate.
Area of Science:
- Orthopedics
- Pediatric Surgery
- Genetics
Background:
- Osteogenesis Imperfecta (OI) is a genetic bone disorder causing fragility and deformity, often requiring surgical intervention.
- The Fassier-Duval (FD) telescopic nail is a preferred surgical option for managing lower limb issues in children with OI.
- This study evaluates the effectiveness of FD telescopic nailing for lower limb deformities and fractures in pediatric OI patients.
Purpose of the Study:
- To prospectively assess the clinical and radiological outcomes of FD telescopic nailing in children with OI.
- To evaluate the impact of FD nails on functional scores, ambulatory ability, and radiographic correction.
- To determine complication and revision surgery rates associated with this treatment.
Main Methods:
- A prospective study involving 31 children with OI undergoing FD telescopic nailing for femur or tibia deformities/fractures.
- Minimum 2-year follow-up, with all patients receiving pre-operative bisphosphonate therapy.
- Assessment of functional outcome scores (BAMF, PODCI), ambulatory ability, radiographic correction, union rates, and complications.
Main Results:
- Significant improvements in BAMF (5.8 to 8.2) and PODCI (42.5 to 46.2) scores were observed (p<0.001).
- Mean angular deformity was corrected from 33.5°/35.6° to approximately 1° (p<0.001).
- Union was achieved in all patients within 6.5 months, with a 22.5% complication rate and 7.5% revision rate.
Conclusions:
- FD telescopic nailing is a valuable short-term treatment for lower limb deformities and fractures in children with OI.
- The procedure leads to significant functional and radiological improvements, enhancing mobility.
- The treatment demonstrates an acceptable rate of complications and revisions.
Background:
Osteogenesis imperfecta (OI) is a genetic disorder of bone fragility and deformity that frequently requires surgical management. The Fassier-Duval (FD) telescopic nail is a treatment of choice for the lower limb deformities and fractures in children with OI, with the aim of decreasing the number of surgeries and improving the results. This study prospectively assesses the clinical and radiological outcomes of FD telescopic nailing in lower limb deformities and fractures in children with OI.
Methods:
This prospective study included 31 children with OI treated for deformities/fractures of the femur or tibia. All had a minimum of 2 years of follow-up, subjected to FD telescopic nailing. All patients were on pre-operative bisphosphonate therapy. Functional outcome scores (BAMF, PODCI), ambulatory ability, radiographic correction (CORA angles), union rates, complication and revision surgery rates were assessed.
Results:
The mean age was 5.7±2.1 years; 18 males, 13 females. Most patients had moderate/severe OI. BAMF score improved from 5.8±1.6 to 8.2±1.3 (p<0.001). PODCI score increased from 42.5±7.2 to 46.2±7.5 (p<0.001). The mean angular coronal/sagittal deformity preoperatively was 33.5°/35.6° and was corrected to ~1° postoperatively (p<0.001). Mean time of callus formation was 5.6 weeks. Union was achieved within 6.5 months in all patients. The overall complication rate was 22.5%. Revision surgery was done in 7.5%.
Conclusions:
FD telescopic nailing with osteotomy is a useful method for short-term treatment of lower limb deformities and fractures in children with OI, with significant functional and radiological improvements, increased mobility, and an acceptable complication/revision rate.
