Intramedullary rod fixation of fibrous dysplasia without use of bisphosphonates

Abstract

Purpose Controversy exists regarding approach to treatment of pediatric patients with fibrous dysplasia. Methods We retrospectively reviewed medical records of seven patients who were treated at our institution for fibrous dysplasia by intramedullary rod fixation without bisphosphonate supplementation. Results Seven patients with a total of ten fibrous dysplasia lesion sites surgically treated by intramedullary rod fixation were included. Of these ten lesion sites, eight demonstrated pathologic fracture at the time of fixation. Complete fracture healing was observed in all eight sites, with no incidence of recurrent pathologic fractures examined radiographically. There were no major infections or neurologic deficits, and lesions appeared to stabilize. Conclusions In this series, intramedullary rod fixation proved to be successful in treatment of acute pathologic fracture and incompletely healed fibrous dysplasia lesions. We observed partial resolution of fibrous dysplasia lesions at all ten sites without significant long-term complications. Following treatment, there were no refractures. Level of evidence Level IV, case series.

Functional and radiological outcomes of a minimally invasive surgical approach to monostotic fibrous dysplasia

“…However, one case had an unsatisfactorily long recovery time (7 months), reflected by the long rehabilitation period following plain ATP reconstruction of a large lytic defect. One prophylactic strategy can be that by Gaski et al, utilizing retrograde unreamed flexible nailing with titanium elastic nails [19]. Although the procedure was used for a pathologic fracture case through a proximal femoral lesion, long-term assessment showed complete fracture healing with full range of motion in the affected hip and no postoperative complications [19].…”

“…One prophylactic strategy can be that by Gaski et al, utilizing retrograde unreamed flexible nailing with titanium elastic nails [19]. Although the procedure was used for a pathologic fracture case through a proximal femoral lesion, long-term assessment showed complete fracture healing with full range of motion in the affected hip and no postoperative complications [19]. Similar to prophylactic bridge plating, this strategy can be opted for the younger patients with open femoral physes to provide stable support throughout the active phase of the disease.…”

“…The authors utilized the system developed by Gaski et al [19] for the radiographic analyses, which entailed comparison of preoperative and postoperative lesion status at last follow-up. Lesions were evaluated by observation of radiolucency, cystic appearance, endosteal scalloping, and both cortical contour and thickness.…”

Treatment of diaphyseal pathological fractures in children with monostotic fibrous dysplasia using cortical strut allografts and internal plating

“…[13] Previous surgical procedures used to treat FD lesions with pathologic fractures include intralesional curettage and bone grafting with or without internal fixation. [5,8,10,14–16]…”

Analysis of long-bone deformity correction in adolescents using osteosynthesis by intramedullary interlocking nails: a preliminary report

“…В детской ортопедической практике применение интрамедуллярного остео-синтеза стержнями с блокированием во многом ограничено наличием функционирующих зон ро-ста и шириной костно-мозгового канала [6]. Су-ществуют единичные публикации, в которых опи-сывается применение данных конструкций при лечении деформаций у детей на фоне фосфат-диа-бета и фиброзной дисплазии [11][12][13]. Кроме это-го, в литературе есть данные об укорачивающих остеотомиях с использованием интрамедулляр-ных стержней с блокированием для устранения неравенства длин конечностей [14], однако мы не нашли детального анализа точности коррекции деформаций длинных трубчатых костей у детей и подростков с применением общепринятых в ор-топедии референтных линий и углов [8,[15][16][17].…”