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In Depth Tutorials and Information
Non-Union of Osteotomies
In most cases involving osteotomies, fixation with
implant and allografts was sufficient to stabilize and
promote union of the osteotomy sites. However, three
patients had follow-up procedures to stabilize previ-
ous osteotomies that had failed to heal within several
months of the first operation. Each involved tibial oste-
otomies, including wedge osteotomies at the proximal
and distal third of the tibia and a supramalleolar oste-
otomy. The diaphyseal osteotomies were stabilized by
applying or tightening allograft struts and the supra-
malleolar osteotomy was revised with additional lock-
ing plates. In all cases, the non-union was successfully
stabilized and evidence of improved healing was seen.
The patient depicted in
Figure 48.5
initially pre-
sented with pain and difficulty with ambulation due to
a severe bowing deformity of the left tibia and fibula.
Orthotic wear was difficult and he had pain with more
than two holes of golf. In order to correct the deformity,
two tibial osteotomies were performed with intramed-
ullary rod fixation resulting in improved alignment,
weight-bearing ability and ambulation. However, over
a period of 2 years of follow-up, non-union persisted at
the site of the proximal osteotomy, causing some pain
and requiring continued use of a brace for ambulation.
In a second procedure, radial allografts were applied at
the site of the previous osteotomies in order to provide
stability and promote healing, and they showed good
incorporation with native bone and bridging of osteot-
omy gaps within 16 months of follow-up. The patient
reported elimination of pain at the osteotomy site and
was able to ambulate without a brace.
FIGURE 48.5
Stabilization of non-union of tibial osteotomies: (A)
preoperative AP view; (B) postoperative AP view; (C) postoperative
lateral view.
correct bowing and internal rotation, supracondylar oste-
otomy of the femur to correct external rotation, replace-
ment of the prominent Bailey-Dubow rod with a Rush
rod and stabilization of the osteotomy sites with tibial
strut allografts and plates. The reconstruction resulted
in improved alignment, decreased pain and increased
weight-bearing tolerance with the left leg.
COMPLICATIONS
Other Surgical Complications
There were relatively few surgical complications
as a result of the procedures, and none developed into
severe or chronic infections or sequelae. One patient
had erythema at the incision site for 1 week following
an operation, and two had persistent drainage from the
incision sites for approximately 6 weeks and 6 months,
respectively. However, none of these showed signs of
serious infection and their symptoms resolved with
time and regular postoperative care. There were no
neurologic or vascular complications.
Development of Prominent Implant
The most common indication for a revision or follow-
up procedure among the patients was the development
of prominent implant. In four cases, existing or newly
implanted fixation became prominent enough to cause
discomfort. Two of these cases involved previously
implanted femoral intramedullary rods that became
more prominent following osteotomies that caused the
limb to become slightly shorter. These were resolved by
either trimming or reinserting the rods to further impact
them. Two cases involved prominent screws, one inter-
locking screw in an IM rod and one set of screws holding
a sandwich allograft in compression. The interlocking
screw became loose within days after initial insertion
and was reinserted and the site injected with methacry-
late to ix it. The allograft screws began to cause discom-
fort 2 years after the allograft was implanted, and the
allograft had incorporated well into the native bone, so
the screws were removed without loss of stability.
SU
MMARY AND CONCLUSIO
NS
●
In adults patients with OI, surgical intervention can
be used to successfully address common sequelae
of the disorder and can increase functional capacity,
particularly with respect to mobility, weight bearing
and improved comfort.
