what-when-how
In Depth Tutorials and Information
CHAPTER
45
Implant Considerations in Long Bones in
Ost
eogenesis Imperfe
cta
François R. Fassier and Marie Gdalevitch
Shriners Hospitals for Children, Montreal, Quebec, Canada
In 1959, Sofield and Millar
1
published the results of
a surgical technique which they had been using at the
Chicago-Shriners hospital since 1948: “Fragmentation,
realignment and intramedullary rod fixation of defor-
mities of the long bones in children.” The patients
treated with this method were mostly osteogenesis
imperfecta (OI) patients (22 of 52) or 80 of 117 reported
surgeries.
Since then, intramedullary (IM) rodding has become
the most popular surgical treatment for long bone
deformities in fragile bone conditions in children.
Despite a recent improvement of the telescopic rod,
5
this issue has yet to be completely resolved. Both tech-
niques are still widely used and are surgeon dependent
as well as “budget” dependent.
As a “mid-term” option, sliding rods have been pro-
posed (also called dual Rush rodding). The surgery con-
sists of inserting two rods upside down: one from the top
down and one from the bottom up. Like the telescopic
rod, the anchorage of each rod is in the epiphysis. During
R
ODDING (TUTOR EFFECT
)
The goal is to help the bone grow straight, reduce
fracture rate and, in case of fracture, prevent the dis-
placement of the bones.
When the implant is a regular rod (Kirschner wire or
Rush pin) after 2 or 3 years the bones usually outgrow
the rods. As a result, fracture or bowing under the tip
of the rod is common. Therefore in 1963, Dubow and
Bailey
2
proposed the principle of a telescopic rod: each
extremity of the rod is fixed in the proximal and the dis-
tal epiphysis of a long bone. During growth, the “male”
rod is pulled out of the “female” rod which elongates
like a radio antenna (
Figure 45.1
).
From then on there have always been discussions
and divisions among pediatric orthopedic surgeons as
to whether the use of a regular rod (cheaper, easier to
install, but needing to be replaced regularly) was better
than the use of a telescopic rod (more expensive, more
difficult to insert, but with fewer reoperations).
3-4
FIGURE 45.1
Femoral rodding with Dubow-Bailey telescopic
rod. Immediate postoperative aspect and at 7 years postoperative,
showing the elongation of the nail.
