Which is the best femoral implant in children with osteogenesis imperfecta? a retrospective cohort study of 783 procedures

BMC Musculoskeletal Disorders, 2023 · DOI: https://doi.org/10.1186/s12891-023-06222-2 · Published: February 3, 2023

Simple Explanation

Osteogenesis imperfecta (OI) is a genetic disorder causing fragile bones and deformities. This study compares four surgical implants used to treat femur (thigh bone) issues in children with OI: telescopic rods, plates and screws, elastic nails, and non-elongating rods. The researchers reviewed data from 783 femur surgeries to see which implant had the best outcomes, considering revision rates (repeat surgeries), how long the implant lasted, and complications like refractures or implant problems. The study found that telescopic rods generally had lower revision rates, longer implant survival, and fewer complications compared to the other three implant types, especially in more severe forms of OI.

Study Duration

20 Years

Participants

783 femoral procedures (541 children)

Evidence Level

Retrospective cohort study

Key Findings

1
Children with Sillence type III (severe OI) had the highest revision rate and shortest implant survival period, while those with type I (mild OI) had the lowest revision rate and longest survival period.
2
In Sillence types III and IV, telescopic rods had significantly lower revision rates compared to plates, elastic nails, and non-elongating rods.
3
Telescopic rods were associated with a statistically lower incidence of refracture, deformity, and implant-related complications.

Research Summary

This retrospective cohort study compared the clinical outcomes of four different femoral implants (telescopic rod, plate and screws, elastic nail, and non-elongating rod) in children with osteogenesis imperfecta (OI). The study found that telescopic rods were associated with lower revision rates, longer implant survival periods, and a lower incidence of refractures, deformities, and implant-related complications, particularly in Sillence types III and IV. The authors conclude that surgical intervention with telescopic rods is an effective way to manage femoral fractures or deformities in children with OI.

Practical Implications

Surgical Planning

Telescopic rods should be considered as a priority for surgical management of femoral fractures and deformities in children with OI, especially those with Sillence types III and IV.

Implant Selection

Surgeons should carefully evaluate the risks and benefits of each implant type, considering the potential for refracture, deformity, and implant-related complications, when choosing a femoral implant for children with OI.

Post-operative Care

Close monitoring for implant-related complications, such as rod migration, is necessary following telescopic rod implantation.

Study Limitations

1
Retrospective study design
2
The age of implant insertion in the telescopic rod group was statistically younger than the non-elongating rod group
3
Bilateral femurs from a single patient were considered independently in the statistical analysis.

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