Internal fixation after fracture or osteotomy of the femur in young children with polyostotic fibrous dysplasia

Abstract

Children from 4 to 7 years of age with polyostotic fibrous dysplasia (PFD) may need internal fixation of the femur for either fracture or osteotomy. At that age, the small size of the femur allows only the use of small intramedullary nails. However, titanium elastic nails and rigid intramedullary pediatric interlocking femoral nails - good for fracture or osteotomy fixation in the normal femur - are not indicated in PFD. From 2009 to 2011, we treated eight cases of PFD femoral fracture and deformity by internal fixation with a custom-modified adult humeral nail to which a spiral blade was connected. The 7-mm thick nail fit properly into the small femoral shaft and the spiral blade conferred ideal mechanical support to the femoral neck. Three cases had replacement of the humeral nail with a more appropriate adult femoral nail 3 years after the index procedure when the femur had reached an adequate size. In the maximum follow-up period of 4 years, few complications were observed.

Individualized approach to the surgical management of fibrous dysplasia of the proximal femur

“…Good functional outcome in the majority Kushare et al (2014) [ 13 ] 16 Intramedullary nails 3 years 1/16 One patient required further surgery and 5 had pain at last follow-up Ippolito et al (2015) [ 16 ] 11 Two stage coxa vara correction and definitive fixation with an interlocking nail 4.7 years 4/11 Four patients had complications after the first surgery and another four needed further surgery after the second implant. Benedetti Valentini et al (2015) [ 15 ] 8 Customized adult humeral nail in children (4–7 years) 2.9 years 3/8 Three patients required revision surgery as an adult. One patient required distal screw removal and acquired nail breakage Present study 5 Intramedullary nails, one of which was customized 4.1 years 0/5 All patients had a good outcome with no worsening of deformities Angled Blade Plate Ippolito et al (2003) [ 11 ] 2 Angled blade plates after valgus osteotomy 4.5 years 1/2 One failed due to cutting out of the plate.…”

“…Treatment of pediatric patients with fibrous dysplasia of the proximal femur calls for a different surgical approach to that of adults with this disease localization, as the growth of the femur has to be accounted for in the placement of internal fixation to avoid damage to the growth plate or to the pediatric vascular circulation of the proximal femur [ 9 , 11 , 37 ]. Moreover, standard intramedullary devices used in adults will generally not fit into the small femoral shaft of children, ruling out their use in most young children, especially in growing patients with an open physis [ 15 ]. Titanium elastic nails (TEN) have frequently been used to address fractures, and although most fractures show good healing, the TENs will not prevent any subsequent fracture or the progression of deformities and should therefore not be used in the proximal femur of young patients with fibrous dysplasia [ 11 , 15 ].…”

“…Moreover, standard intramedullary devices used in adults will generally not fit into the small femoral shaft of children, ruling out their use in most young children, especially in growing patients with an open physis [ 15 ]. Titanium elastic nails (TEN) have frequently been used to address fractures, and although most fractures show good healing, the TENs will not prevent any subsequent fracture or the progression of deformities and should therefore not be used in the proximal femur of young patients with fibrous dysplasia [ 11 , 15 ]. Different intramedullary devices have been proposed, among which humeral nails and a new small diameter pediatric interlocking intramedullary device [ 15 , 23 ].…”

Ti-24Nb-4Zr-8Sn Alloy Pedicle Screw Improves Internal Vertebral Fixation by Reducing Stress-Shielding Effects in a Porcine Model

“…However, the degree of occlusion remains unclear [ 21 , 22 ]. The data show that there is no significant difference between the elastic internal and rigid internal fixation system in the therapy of lumbar degenerative lesions [ 23 ]. Low modulus beta-titanium alloys are hoped to provide good biocompatibility and alleviate stress-shielding effects.…”

Treatment of shepherd's crook deformity in patients with polyostotic fibrous dysplasia using a new type of custom made retrograde intramedullary nail: A technical note

“…3 In other reports, the Fassier-Duval nail had been used and the valgus osteotomy had been stabilised with two angulated pins and cerclage wires. 11 A few cases have been described with the use of an intramedullary Expert-Synthes humeral nail, 12 and one case report describes a patient with a fracture below a long blade plate, where the correction was done with the retrograde insertion of a conventional intramedullary nail from the fracture site. 13 A new device called ‘gap nail’ has been recently presented.…”