Elastic Stable Intramedullary Nailing for the Treatment of Humeral - PowerPoint PPT Presentation

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Elastic Stable Intramedullary Nailing for the Treatment of Humeral

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Humeral & Femoral Fractures in Osteogenesis Imperfecta ... be used safely in fractures of the humerus and femur in Osteogenesis Imperfecta ... – PowerPoint PPT presentation

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Title: Elastic Stable Intramedullary Nailing for the Treatment of Humeral


1
Elastic Stable Intramedullary Nailing for the
Treatment of Humeral Femoral Fractures in
Osteogenesis Imperfecta
  • Rowland DJ, Morgan A, Fernandes JA, Bell MJ
  • Sheffield Childrens Hospital
  • United Kingdom

2
Traditional Treatment of Fractures in OI
  • Plaster
  • Further loss of bone density
  • Plates (ORIF)
  • Risk of peri-implant fracture
  • Telescopic Rods
  • Difficult to insert in presence of deformity from
    previous fractures

3
Elastic Stable Intramedullary Nailing
  • Well recognised technique for management of
    fractures in normal bone
  • Previous concerns in OI regarding technical
    difficulties e.g. cortical penetration and hold
    of nail in metaphysis
  • Flexibility well suited to deformed bones in OI

4
Retrospective Review
  • Review of patients notes theatre logs
  • 7 patients
  • 3 male, 4 female
  • Mean age at fracture 15 years
  • 8 femoral, 2 humeral fractures
  • Standard techniques for ESIN
  • Nails left in situ

5
Results
6
Example 1 - GA
  • Age 13
  • Female
  • Previous femoral rodding
  • Pamidronate
  • Delayed union humeral fracture with painful
    deformity

7
Example 2 - RC
  • Age 13
  • Male
  • Pamidronate

8
Results
  • All progressed to union
  • One humeral and one femoral fracture required
    reinsertion of a nail for prominence after
    displacement of the implant
  • No infections

9
Further surgery
  • Pre-existing deformity
  • Skeletal stability obtained with nails
  • Revised to Sheffield rod once healed

10
Conclusions
  • Elastic Stable Intramedullary Nailing may be used
    safely in fractures of the humerus and femur in
    Osteogenesis Imperfecta
  • The quality of the bone in these patients was
    brittle as a consequence of pamidronate treatment
  • This resulted in shorter oblique and transverse
    fractures, well suited to the ESIN technique
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