Complications after treatment of patients with osteogenesis imperfecta with a Bailey-Dubow rod

Abstract

The purpose of this study was to analyse the complications using the Bailey-Dubow expanding intramedullary rods in patients with osteogenesis imperfecta. Between 1985 and 1996 intramedullary rodding of 107 long bones with expanding Bailey-Dubow rods was performed in 29 patients suffering from osteogenesis imperfecta. Indications for using rods included osseous deformities and bone deformities in combination with fractures. The average follow-up was 3.5 years (range 2 months to 9 years). The total complication rate in these patients was 63.5% (68 rods). The main complication was rod migration often combined with perforation of joint, bone and soft tissue. Additionally, there was a high incidence of new fractures as well as refractures. Other complications like infections, pseudarthrosis, lack of elongation or over-elongation of the rods, and loosening of the T-piece were only rarely seen. Based on our experience and the information available in the literature, the Bailey-Dubow rod is currently the most successful way to stabilize the growing long bones of patients suffering from osteogenesis imperfecta. However, when using this device, the surgeon as well as the parents of the patient must be aware of the high incidence of complications.

Proximal Migration of Femoral Telescopic Rod in Children With Osteogenesis Imperfecta

“…1 Intramedullary fixation is preferred to plate and screws as the latter would invite refracture or angulation at the tip of the plate because of stress riser effect. 5 Series of modifications of intramedullary telescopic rod have been introduced thereafter to overcome its limitations. 3 Bailey and Dubow 4 first introduced extensible rod; however, high complication rate was reported in relation with this delicate implant.…”

Interlocking Telescopic Rod for Patients with Osteogenesis Imperfecta

“…Failure of telescoping and subsequent intramedullary migration of the rod have been reported in several clinical series 6,7,[9][10][11][13][14][15][16]20 . A telescopic rod elongates only when the forces generated by proximal and distal fixation points exceed the friction forces between the sleeve and the obturator and between the hardware and the surrounding tissue.…”

“…This design allowed telescoping elongation as the long bone grew at the physes, and effectively decreased the number and frequency of operations required in growing children [3][4][5][6][7][8] . However, its use was technically demanding, and high rates of operative and postoperative complications were reported 6,[9][10][11][12][13][14][15] . The Sheffield telescopic rod was devised to eliminate problems associated with the T-piece 10 but was nevertheless associated with other complications, such as intra-articular, metaphyseal, or extracortical rod migration.…”

Current and emerging treatments for the management of osteogenesis imperfecta

“…The choice between elongating or non-extensible rods has to be taken with regards to each particular patient and in the particular situation, on the basis of the surgeon's experience. Complications with the use of expanding intramedullary rods in patients with OI are frequent, 52 and the risk is higher in patients aged less than 5 years, and when rods are placed in the tibia rather than the femur. 53 In Italian and French procedures tibial extensible rods have now been replaced by two steel nails with the single extremity flexed in a L fashion to permit elongation.…”