Experience With the Fassier-Duval Telescopic Rod

Birke, Oliver; Davies, Neville; Latimer, Mark; Little, David; Bellemore, Michael

doi:10.1097/bpo.0b013e31821bfb50

Cited by 96 publications

(62 citation statements)

References 13 publications

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“…In children, telescopic rods such as the Fassier-Duval and the Sheffield telescopic intramedullary rod system have gained popularity. These have been shown to correct deformity, prevent fractures, and enhance function (61,62). However, reoperation and complication rates are high.…”

Section: Orthopedic Management Of Deformitymentioning

confidence: 99%

Management of Osteogenesis Imperfecta

Ralston

Gaston

2020

Front. Endocrinol.

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Osteogenesis imperfecta (OI) is the term used to describe a group of rare inherited skeletal disorders characterized by a greatly increased risk of fragility fractures (1). Mutations in several genes can cause OI but the condition is most commonly caused by mutations of COLIA1 or COL1A2 resulting in the production of collagen which is abnormal or present in reduced amounts. Fractures in OI are particularly common during childhood but the elevated fracture risk continues throughout life. Bone mineral density (BMD) can be reduced in OI but the magnitude of increase in fracture risk is far greater than can be accounted for by low BMD, highlighting that a key mechanism of bone fragility is reduced bone quality due to defects of bone matrix and mineralization. A multidisciplinary approach is needed to optimize management of OI, with input from physicians, orthopedic surgeons, physiotherapists, occupational therapists, and other allied health professionals. Orthopedic surgery plays a key role both in the fixation of fractures and in the correction of limb deformities. Bisphosphonates have been widely used in the treatment of children and adults with OI. Although there is good evidence that they increase BMD, it is uncertain to what extent they reduce fracture risk. Clinical trials of bone anabolic drugs such as teriparatide and inhibitors of sclerostin have also been studied; although they increase BMD, studies of these agents have not been powered to look at fracture endpoints. Various other treatment modalities including denosumab, and cell therapy have been explored but haven't gained acceptance in routine clinical practice. There have been huge advances in understanding the pathogenesis of OI but these have not been accompanied by advances in treatment. This signals need for well-designed clinical trials with fracture endpoints in OI, both with existing agents and with the newer therapeutic agents that are now starting to emerge.

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Section: Orthopedic Management Of Deformitymentioning

confidence: 99%

Management of Osteogenesis Imperfecta

Ralston

Gaston

2020

Front. Endocrinol.

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“…Theoretically, with growth, telescoping should allow guided growth to occur, in the same principle as telescopic rods used in the long bones. 13 Another option is the Synthes SCFE Screw System that has a shank diameter which is the same diameter as the screw threads, to facilitate removal. Using the 10 mm thread version of this screw, it is possible to include the thread in the epiphysis of the head and leave the screw proud, and aim for guided growth as the thread stays within the head and drags the smooth shaft with it (Fig.…”

Section: Introductionmentioning

confidence: 99%

Biomechanical considerations in slipped capital femoral epiphysis and insights into prophylactic fixation

Leblanc

Bellemore

Cheng

et al. 2017

Journal of Children's Orthopaedics

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PurposeSlipped capital femoral epiphysis (SCFE) is a deformity of the proximal femur secondary to widened and unstable physis. In stabilising the slip, gold standard treatments stop growth and involve premature physeal closure, which prevents the remodelling of the acquired deformity and creates a leg length discrepancy that may be significant in younger patients.MethodsWe measured the impact of placing threaded screws across the proximal femoral physis by measuring the centre-trochanteric distance (CTD) and articulo-trochanteric distance (ATD) in participants with or without prophylactic fixation. We then compared the mechanical performance of static (stainless and titanium cannulated Synthes screws) and potentially growing implants (Synthes SCFE screw and Pega Medical Free Gliding screw) in a validated synthetic bone model.ResultsIn the review of 30 non-fixed and 60 fixated hips over a mean follow-up of 1.9 years, we have noted a significant difference in pre/post CTD and ATD, as well as the change in CTD and ATD over time. In the biomechanical study, the newer implants allowing growth (Synthes SCFE screw and Pega Medical Free Gliding screw) were both shown to be at least non-inferior.ConclusionsThe primary deformity of a SCFE in itself alters hip mechanics. Also, as confirmed in this study, there is a secondary deformity that is created by static fixation and relative trochanteric overgrowth. To help remodel mild deformities and prevent secondary trochanteric overgrowth, growing implants seem to be non-inferior to the more standard means of fixation in static testing.

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“…The typical operative intervention consists of realignment osteotomies and intramedullary fixation. Over the last 2 decades, new rods and modifications of techniques with less extensive surgical incisions have been introduced to decrease morbidity 9 , 14 , 16 .…”

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confidence: 99%

A Multicenter Study of Intramedullary Rodding in Osteogenesis Imperfecta

et al. 2020

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Background: Osteogenesis imperfecta (OI), a heritable connective tissue disorder with wide clinical variability, predisposes to recurrent fractures and bone deformity. Management requires a multidisciplinary approach in which intramedullary rodding plays an important role, especially for moderate and severe forms. We investigated the patterns of surgical procedures in OI in order to establish the benefits of rodding. The main hypothesis that guided this study was that rodded participants with moderate and severe OI would have lower fracture rates and better mobility. Methods: With data from the Linked Clinical Research Centers, we analyzed rodding status in 558 individuals. Mobility and fracture data in OI Types III and IV were compared between rodded and non-rodded groups. Univariate regression analyses were used to test the association of mobility outcomes with various covariates pertinent to rodding. Results: Of the individuals with OI, 42.1% had undergone rodding (10.7% of those with Type I, 66.4% with Type III, and 67.3% with Type IV). Rodding was performed more frequently and at a younger age in femora compared with tibiae. Expanding intramedullary rods were used more frequently in femora. In Type III, the rate of fractures per year was significantly lower (p ≤ 0.05) for rodded bones. In Type III, the mean scores on the Gillette Functional Assessment Questionnaire (GFAQ) and Brief Assessment of Motor Function (BAMF) were higher in the rodded group. However, Type-IV non-rodded subjects had higher mean scores in nearly all mobility outcomes. OI type, the use of expanding rods in tibiae, and anthropometric measurements were associated with mobility outcomes scores. Conclusions: Current practice in 5 orthopaedic centers with extensive experience treating OI demonstrates that most individuals with moderate and severe types of OI undergo rodding procedures. Individuals with severe OI have improved mobility outcomes and lower fracture rates compared with their non-rodded peers, which suggests that early bilateral rodding benefits OI Type III. Our analysis showed a change in practice patterns in the final years of the study in the severe forms, with earlier and more simultaneous rodding procedures performed. Level of Evidence: Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.

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Experience With the Fassier-Duval Telescopic Rod

Cited by 96 publications

References 13 publications

Management of Osteogenesis Imperfecta

Management of Osteogenesis Imperfecta

Biomechanical considerations in slipped capital femoral epiphysis and insights into prophylactic fixation

A Multicenter Study of Intramedullary Rodding in Osteogenesis Imperfecta

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