title: Fracture in long bones stabilised by telescopic intramedullary rods in patients with osteogenesis imperfecta.
abstract: We investigated the fracture-free survival of long bones stabilised by a telescopic intramedullary rod (TIMR) in patients with osteogenesis imperfecta with respect to the remodelling status of fracture or osteotomy sites and TIMR regions, in order to identify risk factors for fracture. A total of 44 femora and 28 tibiae in 25 patients with a mean age of 5.0 years (1.9 to 10.5) at presentation were studied. There were six patients with Sillence type I, five with type III, 13 with type IV and one with type V osteogenesis imperfecta. All received bisphosphonate treatment at the same stage during the mean follow-up of 7.3 years (0.5 to 18.1). The fracture-free survival was estimated at 6.2 years (95% confidence interval 5.1 to 7.3) by Kaplan-Meier analysis. More than half the fracture or osteotomy sites remained in a less-remodelled state at the latest follow-up or time of fracture. Of the 33 fractures, 29 (87.9%) occurred in long bones containing a less-remodelled site, and these fractures were located at this site. The relative fracture risk at the rod tip was significantly greater than in any other TIMR region (p < 0.001), and this was higher in bone segments having a less-remodelled site. This study shows a persistent fracture risk in TIMR-stabilised long bones, especially at less-remodelled fracture or osteotomy sites and at the rod tip.
authors.affiliation: Division of Paediatric Orthopaedics, Seoul National University, Children's Hospital, 101 Daehang-ro Jongno-gu, Seoul 110-744, Republic of Korea. tjcho@snu.ac.kr
authors.forename: T-J
authors.initials: TJ
authors.lastname: Cho
authors.forename: J-B
authors.initials: JB
authors.lastname: Kim
authors.forename: J W
authors.initials: JW
authors.lastname: Lee
authors.forename: K
authors.initials: K
authors.lastname: Lee
authors.forename: M S
authors.initials: MS
authors.lastname: Park
authors.forename: W J
authors.initials: WJ
authors.lastname: Yoo
authors.forename: C Y
authors.initials: CY
authors.lastname: Chung
authors.forename: I H
authors.initials: IH
authors.lastname: Choi
mesh_terms: D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D001858:Bone Nails / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D004164:Diphosphonates / Q000627:therapeutic use; D004812:Epidemiologic Methods; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging / Q000209:etiology* / Q000517:prevention & control; D006801:Humans; D007223:Infant; D008297:Male; D010013:Osteogenesis Imperfecta / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery*; D010027:Osteotomy / Q000009:adverse effects; D011859:Radiography; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000209:etiology* / Q000517:prevention & control
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates