Fragmentation, Realignment, and Intramedullary Rod Fixation of Deformities of the Long Bones in Children

Abstract

Fragmentation, realignment, and internal fixation with an intramedullary rod have been used in the treatment of osteogenesis imperfecta, congenital pseudarthrosis of the tibia, resistant rickets, fibrous dysplasia, and congenital shortening of the long bones. The method has shown some promise. The use of this technique to stimulate bone growth is still in the experimental stage. Although improved techniques for growth stimulation will probably replace this one, at the present time it appears that some amputations may be avoided by this procedure, pending the development of better methods. The few patients with congenital pseudarthrosis whom we have treated by this method have responded favorably. The procedure may have something to offer, but too few patients have been treated to permit a true evaluation. The use of intramedullary support in cases of osteogenesis imperfecta does not solve the basic error in bone pathology, yet it offers the most promising aid in management in the light of our present experience. The patients with severe cases are made more comfortable and are more easily handled from a nursing standpoint. Some children who would never have been able to walk are now ambulatory. This operation with fixation removes the fear of further refracture with its resultant deformities, and allows the patients to approach, more nearly, the normal activities of growing children. In the field of orthopaedic surgery it seems probable that there are definite conditions in which the operation of fragmentation, realignment, and intramedullary fixation of long bones offers advantages that cannot be obtained by other presently known methods. If performed thoughtfully and carefully, the results should be quite rewarding.