Problems, Complications, and Factors Predisposing to Failure of Fassier-Duval Rodding in Children With Osteogenesis Imperfecta: A Double-center Study

Abstract

Background: Although Fassier-Duval (FD) rods have been used for almost 2 decades, knowledge of factors predisposing to their failure is limited. Thus, the purpose of this study was to: (1) present the most common complications of FD rodding, (2) present tips on how to avoid or overcome them, and (3) identify factors predisposing to treatment failure. Methods: Fifty-eight rod segments in 19 patients with osteogenesis imperfecta (mainly type III) underwent analysis with a median follow-up (FU) time of 4.4 years. We assessed the total number of complications clinically and radiographically. Next, the possible predisposing factors leading to failure were assessed using the Mann-Whitney U test. In addition, we evaluated the cutoff age for the increased rate of complications using the Youden index. A P<0.05 was considered significant. Results: The total number of complications reached 44.8%. The most common complications included: migration of the male or female implant (45.7% and 25.7% out of the total number of complications, respectively), bone fracture with bending of the rod (8.6%), and rotational deformities (8.6%). Significant differences in patients’ ages at the time of surgery were found between the group with and without complications (P=0.04), while sex, segment treated, preceding surgeries, length of FU, FD rod diameter, and length of bisphosphonate treatment were not significant. The Youden index showed that the risk of complications rose significantly in patients treated when younger than 5.5 years of age (P<0.05). Conclusions: This series displays the effectiveness and utility of FD rods at a median FU of over 4 years. Complication rates were comparable with the existing literature, with a notable increase in the number of side effects observed in younger patients (below the age of 5). Level of Evidence: Level IV—therapeutic study.

Surgical Strategy to Decrease the Revision Rate of Fassier–Duval Nailing in the Lower Limbs of Osteogenesis Imperfecta

“…Since 2001, the FD telescopic system has been used in the treatment of OI, congenital pseudarthrosis of the tibia, and, also, other various skeletal dysplasias [ 3 , 4 , 5 ]. The FD telescopic nail has the advantage over regular nails [ 15 , 16 ] of being inserted through one incision without arthrotomy [ 14 , 17 ], however, complications can still occur, with a complication rate ranging from 0% to 53% [ 4 , 6 , 7 ].…”

“…In a review of the literature, the main reasons for revision surgery were migration of the male/female component, refracture/nail bending, and delayed union [ 7 , 18 , 19 ]. In our series, migration of the female component and nail bending were common reasons for failure in the femur, while migration of the male component and delayed union were common reasons for failure in the tibia, which is described in Table 2 .…”

“…Musielak, B.J. et al [ 7 ] reported that the risk factors for FD nail failure were a patient age younger than 5 years and an FD nail diameter smaller than 4 mm. However, few studies have described the possible reasons for nail failure in OI patients.…”

“…The Fassier–Duval (FD) telescoping nail was developed to provide stability during long bone growth, and, currently, it is the most commonly used intramedullary device worldwide [ 3 , 4 , 5 ]. However, the surgical revision rate is still high [ 4 , 6 , 7 ]. The aim of this study was to review the results of OI patients treated with the FD nail at our institution and discuss a surgical strategy to decrease the FD nail revision rate.…”

Which is the best femoral implant in children with osteogenesis imperfecta? a retrospective cohort study of 783 procedures

“…The telescopic rod had lower post-operative incidence of refracture, deformity and implant-related complications compared with the plate, elastic nail and non-elongating rod groups. Although revision surgery was mainly related to subsequent fracture and growth deformity, complications related to the anchorage of the telescopic system can’t be neglected [ 29 – 31 ]. In telescopic group, there were 27 femurs with proximal migration and 23 femurs with distal migration, all of which (15.5%) can be contributed to the anchorage of telescopic system.…”