Bent Telescopic Rods in Patients With Osteogenesis Imperfecta.
BACKGROUND
Telescopic rods require alignment of 2 rods to enable lengthening. A telescopic rod converts functionally into a solid rod if either rod bends, preventing proper engagement. Our goal was to characterize implant bending as a mode of failure of telescopic rods used in the treatment of osteogenesis imperfecta in children.


METHODS
We conducted a retrospective review of our osteogenesis imperfecta database for patients treated with intramedullary telescopic rods at our institution from 1992 through 2010 and identified 12 patients with bent rods. The 6 boys and 6 girls had an average age at the time of initial surgery of 3.1 years (range, 1.8 to 8.3 y) and a total of 51 telescoping rods. Clinic notes, operative reports, and radiographs were reviewed. The rods were analyzed for amount of lengthening, characteristics of bending, presence of cut out, or disengagement from an anchor point. Bends in the rods were characterized by their location on the implant component. The bent and straight rods were compared. Data were analyzed with the Mann-Whitney test (statistical significance set at P≤0.05).


RESULTS
Of the 51 telescoping rods, 17 constructs (33%) bent. The average interval between surgery and rod bending was 4.0 years (range, 0.9 to 8.2 y). Before bending, 11 of 17 telescoping rods had routine follow-up radiographs for review. In 10 of the rods, bending was present when early signs of rod failure were first detected. Rod bending did not seem to be related to rod size. There was no area on the rod itself that seemed more susceptible to bending.


CONCLUSIONS
Rod bending can be an early sign of impending rod failure. When rod bending is first noted, it may predispose the rod to other subsequent failures such as loss of proximal and distal fixation and cut out. Rod bending should be viewed as an indicator for closer monitoring of the patient and discussions regarding future need for rod exchange.


METHODS
Level III-retrospective review.
*Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD †OrthoCarolina, Charlotte, NC ‡Shriners Hospital for Children Honolulu, Honolulu, HI.
R Jay
RJ
Lee
Michael D
MD
Paloski
Paul D
PD
Sponseller
Arabella I
AI
Leet
D002648:Child; D002675:Child, Preschool; D019544:Equipment Failure Analysis; D005260:Female; D006801:Humans; D016268:Internal Fixators / Q000592:standards; D008297:Male; D010013:Osteogenesis Imperfecta / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D010043:Outcome and Process Assessment, Health Care; D019919:Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D011859:Radiography / Q000379:methods; D012189:Retrospective Studies