Telescoping rodding with adjunctive external fixation or threaded wires in osteogenesis imperfecta: evaluation of outcomes

The use of locking plates with intramedullary rodding in children with osteogenesis imperfecta reduces rotational and longitudinal instability. However, adjunctive locking plates do not allow early weight-bearing. We explored the outcomes of intramedullary rodding combined with external fixation or titanium threaded wires (ThW). The study included osteogenesis imperfecta children who underwent surgery with intramedullary telescopic rods and adjunctive fixation with external fixation or ThW. The timing of and reason for implant failure were primary outcome variables. Our cohort consisted of 62 limb segments in 24 patients. The mean external fixation duration was 40.2 days (femur) and 44.3 days (tibia). Patients with external fixation were verticalized with weight-bearing during the first postoperative week. Eleven rod revisions were performed (mean follow-up 50.9 months). We found no fractures after external fixation removal, no rotational displacement, or cortical gaps. We did not observe complications related to ThW. The use of external fixation as an adjunct to telescopic rodding appears feasible and reproducible method for managing deformities in osteogenesis imperfecta children. Use of titanium telescopic rods is associated with a similar revision rate compared to the most commonly used rods. Intramedullary rodding with adjunctive external fixation enables early weight-bearing. Rotational and longitudinal stability ensured by the combined fixation eliminates the risk of secondary rotational displacement, cortical gap, and nonunion. The combination with threaded wires did not show the inconveniences of locking plates used as an adjunct. Results should be interpreted as feasibility data from a retrospective case series.