Bone Abstracts

I. History

II. How the bisphosphonates changed the management plan?

In babies No need to rod non walking children

In toddlers More Upper extremity surgeries

Long-term problems: Risk of delayed non-union:

Several measures were introduced to limit the risk (no Bisphosphonates 48 hours pre-op, and 4 months post-op) as well as technical adjustments.

The duration of the post-op immobilization is still debated

III. Treatment of fractures

Same as in normal bone. The bone is abnormal, but the healing time is normal, therefore, it is illogical to immobilize an OI bone longer than a normal bone.

Bisphosphonates affects osteotomy healing, but not fracture healing, the medication is not stopped.

IV. Lower extremity surgery in OI (hip excepted)

Long bone rodding remains the accepted standard treatment for the correction of deformities. The use of plate and screws must be avoided (stress riser/risk of fracture).

What type of rod?

Static rods (K-wires, Rush rods, elastic rods) have the advantage of being easily available, cheap and relatively easy to use.

Telescopic rods (Dubow-Bailey, Sheffield rod or Fassier-Duval) are more expensive but more difficult to insert. Advantages: The re-operation rates is lower with telescopic rods than with static rods. No need for knee or ankle arthrotomies with FD rods.

When to rod lower extremities?

When the child is ready to pull up to stand AND the bone (tibia/femur) is bowed more than 200, or after the 2nd fracture of the same bone the same year.

How to plan lower extremity rodding?

Ideally: rod a femur first and then homolateral tibia under tourniquet. The second side is operated 1 or 2 weeks later.

Results: Functional results of femoral FD rodding in patients receiving bisphosphonates and post-op rehab show improvement of ambulation beyond physiological gain.

V. Specific Hip Problems

1) Femoral neck fractures

2 Coxa Vara

2) Protrusio Acetabuli

3) OI and DDH

VI. Upper Extremity

The problem is not purely cosmetic!

Medical treatment improves UE function.

Forearm rodding leads to a more significant functional improvement than humeral rodding.

VII. Advantages/limitations of Multidisciplinary Approach

Disclosure: Royalties from PegaMedical.

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