Results of limb reconstruction surgery using a telescopic titanium rod: early findings

Introduction Pediatric limb reconstruction associated with impaired osteogenesis and fragile bone suggests the use of combined techniques with telescopic intramedullary rods left in situ.

The objective was to test the hypothesis that transphyseal telescopic rods applied simultaneously with  an  external fixation device for pediatric femur or tibia lengthening associated with weak and brittle bone in  Ollier disease and osteogenesis imperfecta does not lead to the rod blocking during fixation, does not prevent distraction bone regeneration, lengthening and deformity correction.

Material and methods The study involved four male patients with Ollier disease and a female patient with osteogenesis imperfecta who underwent limb lengthening and/or deformity correction using a combined technique. Ilizarov apparatus was used as an external fixator, and a telescopic titanium rod was placed simultaneously with external fixator. With the bone consolidated, the Ilizarov apparatus was removed and the telescopic rod left in place.

Results The length gain and deformity correction intended were achieved in all patients. No loss of fixation of the threaded rod was observed in the femur and tibia epiphyses, or greater trochanter apophysis during distraction. There was no blocking of the rod telescopes during distraction. The external fixation index was 11.6 days/cm for polysegmental lengthening, 22.6 days/cm to 28.8 days/cm with monosegmental femoral lengthening.

Discussion Limb lengthening with a telescopic rod has the advantages of additional reinforcement through the segment with no risk of intramedullary construct migration as compared with combined lengthening techniques using flexible intramedullary nailing. There were no problems with formation of the distraction regenerate and longer period of external fixation, which can be seen with other techniques.

Conclusion Outcomes in this series indicated the possibility of limb lengthening and simultaneous osteosynthesis using external fixator and a telescopic titanium rod in patients with pathological osteogenesis. No loss of fixation of the threaded parts of the intramedullary rod, no blocking of the sliding parts of the rod were observed during limb lengthening.

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