engleski

Complications of tibial rodding in osteogenesis imperfecta patients

Aim: To present our experience in treating tibial deformity due to osteogenesis imperfecta (OI) with critical view of methods of fixation. Materials and Methods: We report on 11 patients (4 female, 7 male) with osteogenesis imperfecta and multiple long bones deformities (18 tibias), treated at our Department in the period from July 1986 to July 2011. Corrective osteotomies were performed in all patients, followed by various methods of bone fixation. Results: 30 corrective surgeries of the tibias were performed. The median number of tibial corrective surgeries per patient was 2 (range, 1-8 surgeries per patient). Median patient age at time of surgery was 7 years (range, 2-12 years). Various methods of bone fixation were used, namely 2 Rush intramedullary (IM) nails, 13 IM K-wires, 7 IM Nancy elastic nails and 3 IM Fassier-Duval nails. Median follow-up was 6, 5 years (range, 1-25 years). IM fixation of the tibia was found to be more complex when compared to that of the femur. Malposition of the implant (protrusion in the knee or the ankle joint) was noted in 3 patients in which a Rush, Nancy and K-wire were used. In these patients IM fixations had to be shortened soon after primary application. Two patients suffered a refracture with the IM fixation in place. In one patient, a protrusion of the Fassier-Duval nail through the anterior cortex of the distal tibia occured. Conclusion: Surgical treatment of tibial deformity in OI patients by means of IM rodding is burdened with high recurrence of deformity, due to poor bone quality, and complications that follow treatment. Corrective osteotomies followed by various methods of fixation are an important tool in OI deformity treatment, but surgeries are demanding and none of the fixation methods is free of complications. No uniform solution can be applied to every patient, and we believe the treatment should be individualised.

osteogenesis imperfecta; surgery; complications

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