A NEW TELESCOPIC FEMUR NAIL FOR THE TREATMENT OF OSTEOGENESIS IMPERFECTA

Abstract

Purpose: The use of telescopic nails has enabled a reduction in the rate of re-operation during growth from 51% observed with non-telescopic nails to 27%. This difference is less pronounced in the long term due to mechanical complications and secondary joint problems. We report our experience with the telescopic nail developed for osteogenesis imperfecta of the femur. This nail is inserted antegrade via a small superior incision, avoiding the problems associated with surgical approach via the knee joint. The distal and proximal fixation are achieved by screwing the nail into the epiphysis.

Material and methods: The telescopic nail was used for 43 femurs and 1 humerus in 29 children (osteogenesis imperfecta in 28, skeletal dysplasia in 1) who were reviewed at a mean 34 months. Mean age at surgery was 47 months (range 13 months – 11 years).

Results: The telescopic nail deployed normally in 93.2% of the children. Complications not requiring re-operation were observed in 20.5% of the patients: migration of the proximal part of the nail (n=3), material deformation or stress fracture (n=4), loss of distal epiphyseal fixation (n=1). Surgery was required because of complications in three children: intra-articular protrusion of the male part of the nail requiring repositioning, proximal migration of the female part of the nail into the buttocks subsequent to weight-bearing too early, and loss of distal epiphyseal fixation due to inappropriate intra-operative manipulation.

Discussion: These early results (follow-up less than three years) demonstrate that this new implant is useful in osteogenesis imperfecta. It enables minimally invasive treatment and reduces the rate of complications without the risk of knee arthrotomy.