Subject(s)
Primary Health Care , Shoulder Pain , Humans , Shoulder Pain/diagnosis , Shoulder Pain/etiology , ShoulderABSTRACT
AIMS: The Fassier Duval (FD) rod is a third-generation telescopic implant for children with osteogenesis imperfecta (OI). Threaded fixation enables proximal insertion without opening the knee or ankle joint. We have reviewed our combined two-centre experience with this implant. METHODS: In total, 34 children with a mean age of five years (1 to 14) with severe OI have undergone rodding of 72 lower limb long bones (27 tibial, 45 femoral) for recurrent fractures with progressive deformity despite optimized bone health and bisphosphonate therapy. Data were collected prospectively, with 1.5 to 11 years follow-up. RESULTS: A total of 24 patients (33%) required exchange of implants (14 femora and ten tibiae) including 11 rods bending with refracture. Four (5%) required reoperation with implant retention. Loss of proximal fixation in the femur and distal fixation in the tibia were common. Four patients developed coxa vara requiring surgical correction. In total, 13 patients experienced further fractures without rod bending; eight required implant revision. There was one deep infection. The five-year survival rate, with rod revision as the endpoint, was 63% (95% confidence interval (CI) 44% to 77%) for femoral rods, with a mean age at implantation of 4.8 years (1.3 to 14.8), and 64% (95% CI 36% to 82%) for tibial rods, with a mean age at implantation of 5.2 years (2.0 to 13.8). CONCLUSION: FD rods are easier to implant but do not improve on the revision rates reported for second generation T-piece rods. Proximal femoral fixation is problematic in younger children with a partially ossified greater trochanter. Distal tibial fixation typically fails after two years. Future generation implants should address proximal femoral and distal tibial fixation to avoid the majority of complications in this series. Cite this article: Bone Joint J 2020;102-B(8):1048-1055.
Subject(s)
Femoral Fractures/surgery , Fracture Fixation, Intramedullary/methods , Fracture Healing/physiology , Osteogenesis Imperfecta/surgery , Reoperation/methods , Tibial Fractures/surgery , Adolescent , Age Factors , Child , Child, Preschool , Databases, Factual , Female , Femoral Fractures/diagnostic imaging , Femoral Fractures/etiology , Follow-Up Studies , Fracture Fixation, Intramedullary/adverse effects , Fracture Fixation, Intramedullary/instrumentation , Humans , Internal Fixators , Male , Osteogenesis Imperfecta/complications , Osteogenesis Imperfecta/diagnostic imaging , Prospective Studies , Recurrence , Reoperation/statistics & numerical data , Risk Assessment , Severity of Illness Index , Sex Factors , Tibial Fractures/diagnostic imaging , Tibial Fractures/etiology , Time FactorsABSTRACT
Telemedicine has the potential to increase access to both clinical consultation and continuing medical education in Cambodia. We present a Cambodian surgical centre's experience with a collaboration in which complicated orthopaedic cases were presented to a panel of consultants using free online videoconferencing software, providing a combined opportunity for both continuing education and the enhancement of patient care. Effects of the case conference on patient care were examined via a retrospective review and clinician perspectives were elicited via a qualitative survey. The case conference altered patient care in 69% of cases. All Cambodian staff reported learning from the conference and 78% reported changes in their care for patients not presented at the conference. Real-time videoconferencing between consultants in the developed world and physicians in a developing country may be an effective, low-cost and easily replicable means of combining direct benefits to patient care with continuing medical education.
