Multicenter Series of Deformity Correction Using Guided Growth in the Setting of Osteogenesis Imperfecta

Abstract

Background: The mainstay of deformity correction and fracture prevention for patients with osteogenesis imperfecta (OI) includes osteotomies and intramedullary rodding. Guided growth, described in the setting of skeletal dysplasias, offers a less invasive means of deformity correction. We report a multicenter case series of guided growth procedures in the setting of OI. Methods: We retrospectively reviewed patients with OI at three institutions from April 2012 to April 2019: 18 patients underwent guided growth for angular deformity correction with minimum 1-year follow-up or full deformity correction and removal of guided growth hardware. Clinical characteristics, deformity measurements, and complications were collected. Distal femoral and proximal tibial hemiepiphysiodesis was performed using figure-of-eight plates and screws, and distal tibial medial hemiepiphysiodesis with cannulated screws. Preoperative and postoperative lateral distal femoral angle, medial proximal tibial angle, and lateral distal tibial angle were measured. Frequency and descriptive statistics were completed. Results: Eighteen patients with OI (five-I, four-III, six-IV, three-V) underwent 33 guided growth procedures with mean follow-up of 3.09 years; all received routine bisphosphonate treatment. Preoperative and postoperative mean joint angles were measured. The location for hemiepiphysiodesis included 8 distal femoral medial, 2 distal femoral lateral, 8 proximal tibial medial, 3 proximal tibial lateral, and 12 distal tibial medial. Twelve of the 33 procedures were in patients who had an intramedullary rod; 1 demonstrated backout of the epiphyseal and metaphyseal screws of a distal femoral medial figure-of-eight plate. It was revised to a larger plate with longer screws and removed upon completion of deformity correction. Conclusion: Guided growth may be used as an effective means of angular deformity correction with dysplastic OI bone. Having an intramedullary rod did not preclude the use of a guided growth technique. One procedure demonstrated screw backout. Given the short stature associated with OI, performing a guided growth procedure at an early enough age to allow time for correction should be considered. Level of Evidence: Level IV-case series.

What’s new in pediatric lower limb reconstruction?

“…In a retrospective cohort study of 783 patients with OI, Yang et al 70 found that in the treatment of long bone fractures and deformities, intramedullary telescoping rods showed the lowest revision rate and longest implant survival period compared with other fixation techniques, confirming earlier results of a meta-analysis. 71 Franzone et al 72 demonstrated in a multicenter study that GG procedure can be effective in patients with OI. Cyclic intravenous therapy with bisphosphonates has become an established part of the treatment of moderate to severe OI.…”

“…Franzone et al 72 demonstrated in a multicenter study that GG procedure can be effective in patients with OI. Cyclic intravenous therapy with bisphosphonates has become an established part of the treatment of moderate to severe OI.…”

What’s New in Limb Lengthening and Deformity Correction

“…Franzone et al highlighted the role of guided growth surgery in correcting angular deformities in a case series involving 18 patients with osteogenesis imperfecta 47 . Harmer et al described a technique for anterior distal femoral hemiepiphysiodesis using percutaneous cannulated screws to correct knee flexion contractures in patients with cerebral palsy 48 .…”

Gelenkerhaltende Therapie bei Osteogenesis imperfecta

“…Lösung der eingebrachten Schraube beobachtet. In Anbetracht der mit der OI verbundenen Kleinwüchsigkeit sollte die Durchführung eines wachstumslenkenden Verfahrens in einem tendenziell jüngeren Alter erwogen werden, da dieses Prinzip genügend Zeit für eine entsprechende Korrektur benötigt [32].…”