The Use of Kirschner Wire Intramedullary in Pediatric Femur Fractures with Osteogenesis Imperfecta

Abstract

BACKGROUND: Surgical treatment for osteogenesis imperfecta (OI) remains controversial. The use of nonelongating rods is considered to be the classic method. This older method is still used by surgeons who are concerned about the possibility of trauma or who are working in developing countries with fewer resources. We are among those who prefer the use of Kirschner wire (K-W). This article presents the results of intramedullary fixation using K-W and Bisphosphonate treament in children with OI and the proper timing of wire exchange to prevent further fracture. METHODS: We treated 29 femora in 24 patients with OI by means of stabilization using K-W. The patients divided two Variant: (1) Variant 1: femoral fractures fixed by K-W only (10 patients); (2) Variant 2: femoral fractures fixed by K-W and combined treated with bisphosphonates (14 patients). Sillence classification of OI with 4 Types and the features: Type I: Osseous fragility, Adulthood hearing loss, Blue sclera; Type II: Extremety severe osseous fragility, Perinatally lethal; Type III: Moderate to severe osseous fragility, Normal sclera, Severe deformity of the long bones and spine, Variable clinical and radiographic phenotypes; Type IV: Osseous fragility, General normal sclera, Severe deformity of long bones and spine. Our Surgical treatment for acute fracture and for angular deformity correction if present on patients with OI is based on the classic Sofield-Millar technique, evaluating treatment according to El Sobky. RESULTS: Indications for the primary surgery included: fracture were 4 fracture only, and Fracture and deform were 25. There were 24 Patients, Right/left/Bilateral fracture femur in 12/7/5; Total fracture femur 29. There were 45.8% in Type 1, 33.4% in Type 3, and 20.8% in Type 4. The male to female ratio was 1: 1.7. There were 5 (20.8%) patients with family history. The mean age at the primary procedure for K-W was 27.9 months old (range, 18-43 months old). The mean follow-up period was 75.5 months (range, 62 months to 89 months). In this study, Variant 2 (accepted was 57.1%) better than Variant 1 (accepted was 20%). CONCLUSIONS: Documented that children treated with Bisphosphonate prior to surgery and afterwards do better than children treated with surgery alone. We suggested that a surgical treatment using non-extensible nails is indicated when complications such as fractures and/ or deformities are present, based on the fact that these nails do not follow bone growth, if early implanted, complications will eventually occur, resulting in a larger number of review surgeries.