Challenges encountered using Fassier-Duval rods in osteogenesis imperfect

Abstract

Background: Intramedullary fixation remains a mainstay in the management of deformity and fracture in patients with osteogenesis imperfecta (OI). Fassier-Duval telescoping intramedullary rods were introduced in 2003 and have substantially replaced the use of Bailey-Dubow rods in the treatment of OI patients. The purpose of this study was to identify limitations, if any, of the Fassier-Duval rod in this condition. Methods: A retrospective chart and radiograph review was performed of all OI patients treated with Fassier-Duval telescoping rods between the years 2005 and 2017 at a single institution. The clinical records and radiographic studies were reviewed to identify technical challenges intraoperatively and postoperative problems. Results: Twenty procedures were identified in which Fassier-Duval rods were placed in nine patients. Intraoperative technical challenges occurred in six (distal migration of epiphyseal fixation, rod prominence in the knee, distal guidewire protrusion, and fracture). Postoperatively, nine of the 20 Fassier-Duval rods (45%) had failure of epiphyseal fixation and lost their telescoping feature. Three (15%) long bones fractured with the device in place with the rods bending and subsequently requiring revision. One (5%) long bone fractured distal to the rod after loss of epiphyseal fixation. There were no infections. Conclusions: In OI long bone deformities, the goal of the Fassier-Duval rod is to provide realignment with intramedullary stabilization, reduce the number of fractures, and limit reoperations due to the expansion of the telescoping devices. Although the FD rod has the potential to accomplish these goals, challenges remain in this condition. Level of Evidence: Therapeutic level IV.