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Titanium Elastic Nails Successfully Splint Subsequent Femoral Fractures in a Child with Osteogenesis Imperfecta

Authors: Lutomia MBL, MBChB, FCS Orth(ECSA), Lakati KC, MBChB, FCS Orth(ECSA).

Affi liation: Egerton University Medical School, Nakuru orthopaedic Centre, ICRC Geneva.E-mail: mlumbasi77@yahoo.com

 

Summary

The current trend in the management of fractures in children with osteogenesis imperfecta (OI) is the use of expandable nails. These may not be widely available in resource- constrained settings. We report a case of a 9 year old female with a peri-prosthetic fracture treated with premeasured pre-contoured titanium elastic nails allowing rapid mobilization. The nails also provided adequate splintage to subsequent proximal fractures of the same femur a few months later, obviating need for further surgeries. Titanium elastic nails without fluoroscopy are an option for treating fractures in children with OI for the average orthopaedic surgeon in the developing world.

Introduction

Osteogenesis Imperfecta (OI) is a heritable disorder with variable phenotypic expression. The inherent disorder of type 1 collagen synthesis may be associated with blue sclera, dentinogenesis imperfecta, scoliosis, ligamentous laxity and easy bruisability (1-3). Left alone, the children suffer multiple fractures due to severe osteoporosis and the cycle of immobilization and fracture can render their life difficult and restrict ambulation.

 

Various operative options for the fractures are available. The current trend has been use of expandable nails and rods (3-6). The ideal implant should elongate as the child grows, protect the whole bone and prevent subse-quent fractures or at least prevent multiple re- operations from displacement, prevent implant failure, migrations and angulation. Ability to be inserted without fluoros-copy may be advantageous in the developing world.

 

The use of the non-expandable but widely available Ti-tanium Elastic Nails in the treatment of fractures in OI is not widely reported in this continent. We report its use without fluoroscopy as an option for orthopaedic sur-geon in the developing world.

 

Case report

 

A 9 year old girl with Osteogenesis Imperfecta type 1, presented with a distal third right femur fracture after a minor fall at school. She had had multiple bilateral femur fractures from as early as the age of 1 year which were managed by various non-operative methods including hip spica, traction and plaster casts.