[Experiences with different telescope nails in treatment of pediatric osteogenesis imperfecta]

The present study aims to examine and compare results after intramedullary rodding of long bones with the original Bailey/Dubow-nail and two modifications.

During the period 1985 to 1995 21 patients with an average age of 6.3 years (2-11 yrs) underwent intramedullary rodding of 83 long bones. Therefore 38 original Bailey/Dubow-nails, 36 nails with distal screws and 9 nails with distal K-wires were used. The mean observation period amounted to 5.7 years after insertion. Operation success was judged by bone growth, rod elongation, complications, implantation period, revision- and refracture rate.

Bone growth was about 90.6% of the normal value accompanied by an elongation of 71.4%. Best results could be achieved by the use of conventional nails, whereas nails with distal screw or K-wires showed most disturbance. Complications had to be scored in 33.7% and mainly consisted of rod migration with cortical perforation (15.7%), metaphyseal position of the distal screw (9.6%) or no elongation (6.0%). Average implantation period was 4.6 years with a 66.3% revision rate. Refractures after inadequate trauma happened in 3 cases (3.6%) after insertion of the screw-type nail.

The use of elongation rods in children with osteogenesis imperfecta promises successful fracture prevention and a comparably long implantation period. However, the original Bailey/Dubow-nail showed best results although the modified nails had been expected to be superior.