Closed intramedullary rodding for osteogenesis imperfecta

Middleton, R. W. D.

doi:10.1302/0301-620x.66b5.6501356

Cited by 31 publications

(16 citation statements)

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“…Others, such as Williams [11] and Middleton [12], have also described the correction of deformity for children with OI. However, the problem of bone overgrowing the rods with those methods remained, and some rods became completely incorporated in the diaphysis, which could affect future rod retrieval.…”

Section: Introductionmentioning

confidence: 99%

Fassier–Duval femoral rodding in children with osteogenesis imperfecta receiving bisphosphonates: Functional outcomes at one year

Ruck

Dahan‐Oliel

Montpetit

et al. 2011

Journal of Children's Orthopaedics

117

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Purpose To examine the functional outcomes of children with osteogenesis imperfecta (OI) following initial FassierDuval (FD) rodding to the femur at 1 year, and to determine which factors are associated with change in gross motor function, ambulation, and functional performance. Methods Approval from our Institutional Review Board was obtained. A retrospective chart review identified 60 children (28 males, 32 females) with OI who underwent initial FD femoral rodding (101 rods) and who were receiving bisphosphonates. The mean age of the children was 3 years, 11 months at the initial femoral FD rodding. Two had type I OI, 30 type III, 27 type IV, and one type VI. The maximum length of follow-up was 4 years. Telescoping FD rods were used for the femurs, with surgeries performed one leg at a time, with a 1-week interval. The active range of motion (AROM) of the hips and knees in flexion was measured 4-5 weeks post-initial rodding. Outcomes on the Gillette Functional Assessment Questionnaire (FAQ) Ambulation Scale, the Gross Motor Function Measure (GMFM), and the Pediatric Evaluation of Disability Inventory (PEDI) were compared pre-operatively and at 1 year post-surgery using t-tests and multivariate linear regression. Results Pre-operatively, the mean FAQ score was 2.0, and this increased to 5.8 at 1 year post-surgery. Statistically significant improvements (P B 0.05) were found on the FAQ, crawling, standing, walking and running, and total domains of the GMFM, and PEDI mobility and self-care from baseline to 1 year. The results from the multivariate linear regression indicate that older age (P = 0.0045) and higher weight (P = 0.0164) are significantly associated with lower scores in the self-care domain of the PEDI, and that OI type III compared to type IV is significantly associated (P = 0.0457) with greater improvement on the crawling domain of the GMFM. Higher weight was also associated (P = 0.0289) with lower scores in the standing domain of the GMFM, as well as with the total GMFM score (P = 0.0398). Conclusions Our findings indicate that initial FD femoral rodding resulted in benefits in ambulation, gross motor function, self-care, and mobility for children with OI beyond physiological expectations due to developmental growth. FD rodding is a procedure which can improve the overall mobility in children with OI with significant femoral deformities.

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Section: Introductionmentioning

confidence: 99%

Fassier–Duval femoral rodding in children with osteogenesis imperfecta receiving bisphosphonates: Functional outcomes at one year

Ruck

Dahan‐Oliel

Montpetit

et al. 2011

Journal of Children's Orthopaedics

117

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“…A melhor idade para a execução do procedimento cirúrgico seria quando o paciente inicia a marcha, auxiliando-o no seu desenvolvimento (22) , muito embora isto dependa sempre da gravidade da doença. Pacientes menores que três ou quatro anos com tipos mais graves de OI podem ser submetidos à osteoclasia fechada e fixação intramedular percutânea, propiciando a correção das deformidades e estabilização óssea com um procedimento menos invasivo, sem comprometer futuros tratamentos (14,15) .…”

Section: Embora a Cirurgia De Sofield E Millarunclassified

“…Therefore, with bone growth, the rod has become relatively smaller, allowing the metaphysial bone segment that is not protected and supported to deform, with a tendency to fracture or rod extrusion (Figure 4). Revisions are, therefore, required at 2-2,5-year intervals approximately (4,5,10,15,16) . In our patients surgical revisions were performed following 3 years and 6 months, on average, probably due to the fact that our sample included patients who had been operated when they were aged 10 years and 2 months, on average, and had, therefore, a smaller potential for residual growth.…”

Section: Embora a Cirurgia De Sofield E Millarmentioning

confidence: 99%

“…These rods are able to passively elongate since their extremities are not fixed on bones. With the use of this device, surgical revision is avoided in many cases, since extensible rods accompany bone growth (15) . In patients with skeletal maturity or in whom a bone growth < 3 cm is expected, nonextensible rods are indicated since the risk for deformity recurrence or fracture is lower (16).…”

Section: Embora a Cirurgia De Sofield E Millarmentioning

confidence: 99%

“…On the one hand, surgical revision is delayed, but, on the other hand, extensible rods are associated with increased morbidity because surgical duration is increased due to technical difficulty. In addition, a great number of complications are associated with this procedure (15,17,18) . Neurovascular complications or infections were not seen although Sofield e Millar technique (10) seems to be very aggressive.…”

Section: Embora a Cirurgia De Sofield E Millarmentioning

confidence: 99%

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A operação de Sofield e Millar no tratamento da osteogênese imperfeita

Santili¹,

Akkari²,

Waisberg³

et al. 2004

Acta ortop. bras.

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ARTIGO ORIGINAL / ORIGINAL ARTICLE RESUMOA osteogênese imperfeita é uma doença genética causada por um defeito do colágeno do tipo I. Os portadores caracterizam-se pela baixa estatura, escleras azuladas, deformidades esqueléticas e fragilidade óssea. Os autores analisam os resultados da operação de Sofield e Millar que foi realizada em 23 ossos acometidos em oito portadores de osteogênese imperfeita com deformidades e antecedentes de múltiplas fraturas. Após um seguimento médio de dez anos e dois meses, onze ossos não precisaram ser reoperados; doze ossos, no entanto, apresentaram 21 complicações pós-cirúrgicas sendo: dez migrações das hastes intra-medulares, seis refraturas, três recidivas da deformidade e duas pseudartroses. Não houve caso de infecção ou lesão neurovascular. A reoperação, quando necessária, ocorreu após um tempo médio de três anos e seis meses. Todos os pacientes melhoraram ou mantiveram a capacidade de deambulação logo após a cirurgia; porém, com o tempo, dois deles, portadores de formas mais graves da doença, deterioraram sua capacidade de deambulação tornando-se não deambuladores. Os autores concluem que a operação torna possível a correção das deformidades e previne temporariamente a sua recidiva, além de tornar as fraturas menos freqüentes. No entanto, devido ao crescimento esquelético e a indistensibilidade das hastes intramedulares utilizadas, as complicações ocorrem.Descritores: Osteogênese imperfeita; Marcha; Osteotomia SUMMARYOsteogenesis imperfecta is a genetic disease caused by defects in the synthesis of type I collagen; clinical characteristics are short stature, blue or gray sclera, skeletal deformities and bone fragility. We analyzed eight cases of osteogenesis imperfecta with deformities and history of many fractures, for that the Sofield and Millar surgery was performed in 23 bones. After a mean follow up period of ten years and two months, 11 bones did not need revision, twelve bones had 21 complication that needed revision, ten by rod migration, six by refracture, three by new deformities and two by nonunion. There were no cases of infection or neurovascular lesion. This surgery was able to correct deformities, make fracture less frequent and prevent new deformities; revisions were necessary three years and two months after the primary surgery. All patients maintained or improved their ability to walk right after surgery; during the follow up, two patients, in which the disease was more severe, had their walking ability decreased and are non ambulatory now. INTRODUÇÃOA osteogênese imperfeita (OI) é uma doença genética causada por um defeito qualitativo e quantitativo na síntese do colágeno do tipo I. Incide em aproximadamente 1:20000 nascimentos, não havendo prevalência racial ou étnica (17,18) .O quadro clínico é de grande variabilidade, sendo que os indivíduos acometidos, de forma geral, apresentam baixa estatura, osteopenia, múltiplas fraturas e deformidades ósseas progressivas. Características adicionais são: escleras azuis ou acinzentadas, dentinogênese imperfeita, fr...

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Intramedullary Stabilization of the Long Bones in Children with Osteogenesis Imperfecta

Topouchian

Finidori

Glorion

Practice of Intramedullary Locked Nails

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Closed intramedullary rodding for osteogenesis imperfecta

Abstract: Three cases of severe osteogenesis imperfecta are reported. Each was treated by closed intramedullary rodding, combined with osteoclasis to correct deformity. Operation was performed within a few months of birth. Both tibiae

Cited by 31 publications

References 2 publications

Fassier–Duval femoral rodding in children with osteogenesis imperfecta receiving bisphosphonates: Functional outcomes at one year

Fassier–Duval femoral rodding in children with osteogenesis imperfecta receiving bisphosphonates: Functional outcomes at one year

A operação de Sofield e Millar no tratamento da osteogênese imperfeita

Intramedullary Stabilization of the Long Bones in Children with Osteogenesis Imperfecta

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