Efficacies of multilevel osteotomy plus rigid intramedullary nail fixation for correcting deformity in elder children with X-linked hypophosphatemic rickets

Abstract

Objective To retrospectively assess the outcomes and influencing factors of correcting deformity with multilevel osteotomy plus rigid intramedullary nail fixation in elder children with X-linked hypophosphatemic rickets (X-LHPR). Methods From August 2007 to December 2016, 17 X-LHPR children (5 boys and 12 girls) were admitted for deformity correction. The mean operative age was 153 (133-183) months. All of them had bilateral lower limb malalignments, including 28 limbs in varus and 8 limbs in valgus. Results Among 55 corrective procedures, 26 limbs (21 varus, 5 valgus) underwent intramedullary nail fixations, including 16 anteriograde femoral, 6 retrograde femoral and 17 tibial segments. The follow-ups were conducted for an average period of 40.5 (14-96) months after initial surgery. Osteotomic healing was obtained within a mean period of 6.3 (4-9) months and normal weight-bearing was restored. There was no occurrence of infections, neurovascular complications or nonunion. At the latest follow-up, mechanical axis was ultimately located in Zone 1 for 9 limbs. Another 9 limbs were in Zone 2 and 4 limbs in Zone 3. Overall fineness rate was 81.8%. Conclusions For elder X-LHPR children, excellent outcomes of deformity correction may be achieved by multilevel osteotomy plus intramedullary nail fixation. Key words: Rickets; Osteotomy; Fracture fixation, intramedullary