title: Osteotomy Healing in Children With Osteogenesis Imperfecta Receiving Bisphosphonate Treatment.
abstract: A decade ago our group had reported that osteotomy healing was commonly delayed in children with moderate to severe osteogenesis imperfecta (OI) who were treated with intravenous pamidronate infusions. We subsequently maintained a bisphosphonate infusion-free interval of 4 months after osteotomy and changed the surgical approach (use of an osteotome instead of a power saw). In addition, zoledronic acid has become the standard intravenous bisphosphonate for treatment of OI at our institution. In the present study, we compared osteotomy healing before and after these changes were instituted. We evaluated bone healing post-osteotomy on standard radiographs after 261 intramedullary rodding procedures involving osteotomies (139 femur, 112 tibia) in 110 patients (age at surgery 1.2 to 20.4 years). Delayed healing was diagnosed when the osteotomy line was visible 12 months after the event. We observed delayed bone healing after 48 of the 114 osteotomies (42%) performed with the new approach, and in 106 of the 147 osteotomies (72%) using the previous approach (p = 0.001). The odds for delayed osteotomy healing were significantly lower with the new approach even after adjustment for age, sex, height Z-score, weight Z-score, OI type, and bone involved (odds ratio = 0.17; 95% confidence interval 0.16-0.47). Thus, delayed osteotomy healing occurred less frequently in the past 10 years than in the decade before that. It is likely that this improved result is attributable to the implemented changes in both medical and surgical management.
authors.affiliation: Division of Orthopedic Surgery, Shriners Hospital for Children, Montreal Children's Hospital, and McGill University, Montreal, Canada.|Department of Orthopedic Surgery, King Abdulaziz University, Jeddah, Saudi Arabia.
authors.forename: Emad A
authors.initials: EA
authors.lastname: Anam
authors.affiliation: Shriners Hospital for Children, and McGill University, Montreal, Canada.
authors.forename: Frank
authors.initials: F
authors.lastname: Rauch
authors.affiliation: Shriners Hospital for Children, and McGill University, Montreal, Canada.
authors.forename: Francis H
authors.initials: FH
authors.lastname: Glorieux
authors.affiliation: Division of Orthopedic Surgery, Shriners Hospital for Children, Montreal Children's Hospital, and McGill University, Montreal, Canada.
authors.forename: François
authors.initials: F
authors.lastname: Fassier
authors.affiliation: Division of Orthopedic Surgery, Shriners Hospital for Children, Montreal Children's Hospital, and McGill University, Montreal, Canada.
authors.forename: Reggie
authors.initials: R
authors.lastname: Hamdy
mesh_terms: D000293:Adolescent; D000328:Adult; D001861:Bone Regeneration / Q000187:drug effects*; D002648:Child; D002675:Child, Preschool; D004164:Diphosphonates / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007093:Imidazoles / Q000008:administration & dosage*; D007223:Infant; D008297:Male; D010013:Osteogenesis Imperfecta / Q000000981:diagnostic imaging / Q000628:therapy; D010027:Osteotomy; D011859:Radiography; D012189:Retrospective Studies; D000077211:Zoledronic Acid
chemical_list: D004164:Diphosphonates; D007093:Imidazoles; D000077211:Zoledronic Acid
keywords: ANTIRESORPTIVES; BONE HEALING; IMPLANTS; OSTEOGENESIS IMPERFECTA; ZOLEDRONIC ACID