what-when-how
In Depth Tutorials and Information
FIGURE 46.7
Drawing of the different extensible intramedullary devices used to manage patients with OI: (A) Bailey-Dubow rod; (B) inter-
locking extensible nail; (C) Fassier-Duval rod and (D) dual Rush rods.
As an alternative to these telescoping devices, the
use of overlapping Rush rods in the femur have been
described by Luhmann et al.
61
They found this tech-
nique particularly useful in patients with relatively
large femoral bony canals. In this technique, one rod
is placed antegrade through the tip of the greater tro-
chanter and a second rod is placed retrograde through
the central portion of the intercondylar area of the
femur. Both rods are countersunk (
Figure 46.7
). These
authors noted that the fixation provided by the com-
bined diameter of two Rush rods was greater than that
which would have been achieved by using the largest
diameter Bailey-Dubow nail. They reported no compli-
cations related to the use of overlapping Rush rods at
latest follow-up.
Joseph et al.
92
analyzed the outcome of intramedul-
lary rodding of 50 femoral and 25 tibial segments. The
techniques of femoral rodding included single Rush
rodding, dual Rush rodding and Sheffield telescoping
rodding. Single Rush rods or Sheffield rods were used
in the tibia. The authors found using dual Rush rods
to be technically more demanding than using Sheffield
rods in the femur, but the results were comparable. For
operations on the tibia, they concluded that using a sin-
gle Rush rod was preferable to using a Sheffield nail.
The original technique described by Sofield and
Millar
73
involved an extensive exposure of the bone
from the proximal to the distal metaphysis. More
recently, a modified approach has been advocated
involving minimal exposure of the bone through a small
lateral approach, preservation and repair of the perios-
teum and minimizing the number of osteotomies to that
needed to correct the deformity.
56,70,77,78
To facilitate this
(A)
(B)
(C)
FIGURE 46.8
(A) A radiograph showing a femur fracture in a
child with severe OI. (B) Anteroposterior and (C) lateral radiographs
demonstrating stabilization of the fracture using a Fassier-Duval rod.
