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

Hung, Yi-Chi; Cheng, Kai-Yuan; Lin, Hsiang‐Yu; Lin, Shuan‐Pei; Yang, Caifeng; Liu, Shih‐Chia

doi:10.3390/jpm12071151

Cited by 5 publications

(6 citation statements)

References 20 publications

(35 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In this study, one third of patients who received a telescopic rod required revision surgery during the follow-up period. This is slightly improved from previous studies that showed 53% to 58% revision rates 12,15,16…”

Section: Discussionsupporting

confidence: 53%

“…This is slightly improved from previous studies that showed 53% to 58% revision rates. 12,15,16 In our study, bent implants were an indication for revision in nearly half of the revision cases (48.2%), making it the most frequent reason for revision. This is different from the series reported by Musielak et al 17 who found that the migration of the male component was the most common indication for revision, accounting for 45% of revisions, with bent rods accounting for 8.6% of revisions.…”

Section: Discussionmentioning

confidence: 52%

“…This is different from the series reported by Musielak et al 17 who found that the migration of the male component was the most common indication for revision, accounting for 45% of revisions, with bent rods accounting for 8.6% of revisions. Hung et al 16 reported a bending rate of 19%, and Azzam et al reported a bending rate of 18%, both citing bending as 1 of their indications for revision surgery. 12 Prior studies have discussed the complexity of surgical removal of bent rods, typically requiring osteotomies at the apex of the bend and additional exposures.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, it is useful to know whether these bent rods continue to function in terms of preventing fracture and progressive deformity. If so, they may not necessarily require revision, especially considering prior studies citing the “bending” of the Fassier-Duval rod to be an indication of failure 14,16,18. This study aimed to determine the natural history of patients with bent telescopic rods and the implications of leaving bent implants in place, such as refracture, worsening deformity, or failure to telescope.…”

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

The Fate of the Bent Rod in Children With Osteogenesis Imperfecta

Fralinger

Kraft

Rogers

et al. 2023

Journal of Pediatric Orthopaedics

View full text Add to dashboard Cite

Background: Osteogenesis imperfecta (OI) is a genetic disorder characterized by brittle bones and long bone deformity. Realignment and intramedullary rodding with telescopic rods are indicated for progressive deformity and can help prevent fractures. Rod bending is a reported complication of telescopic rods and a common indication for revision; however, the fate of bent lower extremity telescopic rods in the setting of OI has not been reported. Methods: Patients with OI at a single institution who underwent lower extremity telescopic rod placement with at least 1-year follow-up were identified. Bent rods were identified, and for these bone segments, we collected the location and angle of bend, subsequent telescoping, refracture, increasing angulation of bend, and date of revision. Results: One hundred sixty-eight telescopic rods in 43 patients were identified. Forty-six rods (27.4%) bent during follow-up, with an average angulation of 7.3 (range: 1 to 24) degrees. In patients with severe OI, 15.7% of rods bent compared with 35.7% in nonsevere OI (P = 0.003). The proportion of bent rods was different between independent and nonindependent ambulators (34.1% and 20.5%; P = 0.035). Twenty-seven bent rods (58.7%) were revised, with 12 rods (26.0%) revised early (within 90 d). The angulation of rods that were revised early was significantly higher than rods not (14.6 and 4.3 degrees, P < 0.001). Of the 34 bent rods not revised early, the average time to revision or final follow-up was 29.1 months. Twenty-five rods (73.5%) continued to telescope, 14 (41.2%) increased in angulation (average 3.2 degrees), and 10 bones (29.4%) refractured. None of the refractures required immediate rod revision. Two bones had multiple refractures. Conclusions: Bending is a common complication of telescopic rods in the lower extremities of patients with OI. It is more common in independent ambulators and patients with nonsevere OI, possibly because of the increased demand placed on the rods. Rods with a small bend and maintained fixation can telescope and need not be an indication for immediate revision.

show abstract

Section: Discussionsupporting

confidence: 53%

Section: Discussionmentioning

confidence: 52%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

The Fate of the Bent Rod in Children With Osteogenesis Imperfecta

Fralinger

Kraft

Rogers

et al. 2023

Journal of Pediatric Orthopaedics

View full text Add to dashboard Cite

show abstract

“…Common reasons for implant failure in the femur include bending and female component migration. The average interval between previous FD nail insertion and revision surgery was 2.4 years [ 8 ]. Taking this into consideration, we can reasonably conclude that the female component migration in the left femur experienced by the patient in this study is not an unforeseen complication that may require reoperation in the future.…”

Section: Discussionmentioning

confidence: 99%

A Fracture From a Physical Exam: A Case Report of Osteogenesis Imperfecta and the Use of Fassier-Duval Rods

Rella¹,

Brandon²,

Garrison³

et al. 2023

Cureus

View full text Add to dashboard Cite

Osteogenesis Imperfecta (OI) is a rare hereditary disorder that leads to fragile bone mineralization and is most often due to a genetic defect in type I collagen, the primary collagen subtype that comprises bone. Patients with OI suffer from a significant burden of fractures and bony deformities. It has been recognized in countries throughout the world and has a variable age and severity of presentation depending on the subtype of OI. Recognition of this disorder requires a high index of suspicion on the part of the clinician, as it can easily be mistaken for non-accidental trauma in children. The current approach to care for patients with this disorder comprises surgical care with intramedullary rod fixation, cyclic bisphosphonate therapy, and rehabilitation to maximize the patient's quality of life and function. This case report demonstrates the importance of considering OI in the differential diagnosis of a child presenting with recurrent fractures so that appropriate testing and treatment interventions can be implemented.The case presented here is that of a male patient with osteogenesis imperfecta who suffered from recurrent long bone fractures, including his femurs bilaterally. His index fracture occurred after a visit to the pediatric ER for an unrelated issue, where his mother claimed that the boy demonstrated pain in his affected leg shortly after the visit. There was a delay in his diagnosis, and the patient suffered multiple fractures before undergoing the insertion of Fassier-Duval rods bilaterally into his femurs to prevent further injury.

show abstract