Serviço de Ortopedia, Hospital de Dona Estefânia, Centro Hospitalar Lisboa Central, E.P.E.
- European Pediatric Orthopaedic Society Congress, 18-21/4/2012, Helsínquia.
Aim: The aim of this work is to evaluate telescopic interlocking rods indications and pitfalls, with clinical and radiological results in our department.
Methods: We followed 27 patients with OI. 8 of them were submitted to 26 surgical procedures. 16 of these surgeries consisted in primary or revision telescopic interlocking rodding, 1 in rodding revision, 5 in simple nailing and 4 in rod/nail simple removal.
We retrospectively analyzed medical patient records. We evaluated age, sex, OI type, pamidronate treatments, previous fractures, prior and posterior walk ability (GMFCS 1-5), current pain (VAS 1-10) and parental satisfaction (telephone survey).
For each procedure, we assessed bone growth (telescoping), complications (re-interventions, fixation loss, physeal growth disturbances, infections and nonunion).
Results: Intramedulary rodding was performed in 15 femurs and 6 tibias; 8 of them were primary or revisions of simple elastic nails. Average age was 9 (follow up 23 months). There were 5 complications: one loss of fixation and proximal migration of the implant requiring re-intervention, a distal migration, and 3 procedures without telescoping effect. There were no infections or nonunion. Patients are pain free. All parents are satisfied with the treatment. Half of the patients improved 1 or 2 points in the GMFCS scale (no worsening in others).
Some patients underwent surgery following fractures taking advantage for deformity correction and prevention of future fractures. Clinical results and low complication rates are encouraging in the treatment of this complex and disabling condition. Probably sooner, prophylactic treatments will be started in the future.
Conclusion: The use of telescopic rods is an unquestionable benefit in the treatment of patients with OI. Technical difficulty advise the use of reference centers for medical and surgical treatment.
Key-words: interlocking telescopic rod, osteogenesis imperfecta, indications, pitfalls.