‘In-Out-In’ K-wires sliding in severe tibial deformities of osteogenesis imperfecta: a technical note
| Autor: | Tristan Langlais, Ruben Dukan, Stéphanie Pannier, Georges Finidori, Marine De Tienda, Christophe Glorion, Zagorka Pejin |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Metaphysis law.invention Intramedullary rod Fracture Fixation Internal 03 medical and health sciences 0302 clinical medicine law Deformity Humans Medicine Orthopedics and Sports Medicine Tibia Child 030222 orthopedics Osteosynthesis business.industry Infant Osteogenesis Imperfecta medicine.disease Osteotomy Surgery Diaphysis medicine.anatomical_structure Epiphysis Osteogenesis imperfecta Child Preschool Pediatrics Perinatology and Child Health medicine.symptom business 030217 neurology & neurosurgery Bone Wires |
| Zdroj: | Journal of Pediatric Orthopaedics B. 30:257-263 |
| ISSN: | 1060-152X |
| Popis: | Severe infant osteogenesis imperfecta requires osteosynthesis. Intramedullary tibia's osteosynthesis is a technical challenge given the deformity and the medullar canal's narrowness. We describe an extramedullary technique: 'In-Out-In' K-wires sliding. We performed an anteromedial diaphysis approach. The periosteum was released while preserving its posterior vascular attachments. To obtain a straight leg, we did numerous osteotomies as many times as necessary. K-wires ('In') were introduced into the proximal epiphysis, and the medial malleolus ('Out') bordered the cortical and ('In') reach their opposite metaphysis. K-wires were cut, curved and impacted at their respective epiphysis ends to allow a telescopic effect. All tibial fragments are strapped on K-wires, and the periosteum was sutured over it. Our inclusion criteria were children with osteogenesis imperfecta operated before 6 years old whose verticalization was impossible. Seven patients (11 tibias) are included (2006-2016) with a mean surgery's age of 3.3 ± 1.1 years old. All patients received intravenous bisphosphonates preoperatively. The follow-up was 6.1 ± 2.7 years. All patients could stand up with supports, and the flexion deformity correction was 46.7 ± 14.2°. Osteosynthesis was changed in nine tibias for the arrest of telescoping with flexion deformity recurrence and meantime first session-revision was 3.8 ± 1.7 years. At revision, K-wires overlap had decreased by 55 ± 23%. Including all surgeries, three distal K-wires migrations were observed, and the number of surgical procedures was 2.5/tibia. No growth arrest and other complications reported. 'In-Out-In' K-wires sliding can be considered in select cases where the absence of a medullary canal prevents the insertion of intramedullary rod or as a salvage or alternative procedure mode of fixation. It can perform in severe infant osteogenesis imperfecta under 6 years old with few complications and good survival time. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|