engleski

Treatment of fractures and deformities in children with osteogenesis imperfecta by minimal invasive surgery approach

Objective: To present principles and the first results of treatment with minimally invasive surgery (MIS) approach and intramedullary expandable rods in children with osteogenesis imperfecta (OI). Patients and methods: There are thirty-nine individuals with OI in our institution patient’ s data base. Currently, seven-teen are in the adult group. From 1978 till 2003 six-teen patients (adults and children) were surgically treated due to fractures and complex deformities of long bones. In the last five years MIS approach with intramedullary expandable rod and no more than three osteotomies was applied. Six children (M4/F2) with eight limb segments were treated. In the four children correction and fixation of femur with intramedullary expandable rod (Sheffield) was done. In two children with lower leg segments, one with femur fracture and in one girl with forearm deformity elastic intramedullary (Nancy) fixation was performed. Post surgery immobilization was short, with three weeks in plaster of Paris. The aim of vigorous rehabilitation was to restore muscular strength and joint mobility with ultimate goal to achieve as much limb function as possible. Results: According to most recent X-ray follow-up all bones were united and the limb axes were restored in all patients. No re-fracture in limb segments was noted. Over-all function of the limb was significantly improved in all children. But the ultimate goal of independent walking was not achieved in two patients due to severity of OI and other disease related and associated problems. Intraoperative use of portable X-ray device is essential to achieve two of three osteotomies in children with OI. Conclusion: MIS approach is safe and possible to apply in children with complex OI limb deformities using adequate technical equipment.

orthopaedics; osteogenesis imperfecta; fractures; deformities; minimal invasive surgery

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