Long Bone Fixation by Fassier-Duval Telescopic Im System in Children with Osteogenesis Imperfecta

Michael Assaf Haim Shtarker
Pediatric Orthopaedics, Naharia Hospital, Myilia, Israel

Introduction: Many different fixation methods for long bones were used in the last 50 years for treating patients with OI .We report our experience with fixation of long bones by the Fassier-Duval telescopic IM system in children with osteogenesis imperfecta in 11 patients, which were performed in the last ten years as definitive treatment for the prevention of fractures and deformity correction.

Patients & Methods: 28 patients with OI are treated at the Israeli Centre for OI in Nahariya. 11 of them were treated by multiple osteotomies and fixation by the Fassier-Duval telescopic IM system. The average age of patients in the group was 7.1 (5- 8) years. It included 7 males and 4 females. All 11 children were diagnosed with OI : six with Type I, three with Type III, one had an unrecognized type and one with Type V. 11 intramedullary telescopic femoral nails, 16 tibial and one humeral nail were performed. In two cases with severe comminution, a supplementary external fixator was needed.

Results: Fracture healing at the osteotomy site was achieved in all cases. All patients were free of pain. No cases of infection were observed, nor were cases of postoperative contracture of knee joint. No growth arrest was observed after surgery. Normal alignment was restored in all cases with previous malalignment of femur and tibia. One patient with OI Type III perforation of distal locking of “male” nail through femoral condyle. One case had a bended nail.

Conclusions:. The Fassier-Duval telescopic nail has proven useful, successful and more secure for fixation of long bones in osteogenesis imperfecta than any other devices used before for treatment of this pathology. The surgical technique is complicated but well developed and the complications can be treated successfully.