Tag Archive for: Adolescent

Surgical and Medical Management of Deformity and Non-union with Implant Failure of Femur in OI Type III

Volume 8 | Issue 1 | January-April 2022 | Page: 35-42 | Sanjay Chhawra, Raman Jain, Unus Ahmed, Nimish Agarwal, Rajiv Chaubey, Gaganpreet Singh
DOI-10.13107/ijpo.2022.v08i01.132

Authors: Sanjay Chhawra D Ortho., DNB Ortho. FICS, Raman Jain MS Ortho., Unus Ahmed MS Ortho., Nimish Agarwal MS Ortho., Rajiv Chaubey MS Ortho., Gaganpreet Singh MS Ortho.

[1] Department of Orthopedics, Jaipur Golden Hospital, Rohini, Delhi, India.

Address of Correspondence
Dr. Sanjay Chhawra
Department of Orthopedics, Jaipur Golden Hospital, Rohini, Delhi, India.
E-mail: sanjaychhawra@yahoo.com

Abstract

Purpose: Osteogenesis imperfecta (OI) is characterized by increased bone fragility and susceptibility for fracture because of the mutation of genes. A few studies are there for treatment modalities of non-union femur fractures in children with OI. This study on adult OI patients aims to give insight into non-unions and their best treatment reporting the surgical modification by using a humeral nail for femoral fixation options to avert non-union. Best implant in the adolescent OI patients for the surgical reconstruction of the femur for correction of deformity healing non-union.
Methods: This is a retrospective, descriptive study of the OI type III fracture non-union and its treatment modality.
Conclusions: In Adolescent OI patients with the rare percentage of non-union with deformity with implant failure of the femur was fixed with Humerus nail having stable fixation deformity correction by both osteotomy rotational translational and conversion of non-union to union with a better result.
Keywords: Osteogenesis imperfecta (OI), TENS Tensile Elastic Nail System, Adolescent, Humeral nail, Femoral bowing deformity

References

1. Caouette C, Rauch F et al: Biomechanical analysis of fracture risk associated with tibia deformity in children with osteogenesis imperfecta: A finite element analysis. J Musculoskeletal Neuronal Interact, 2014; 14(2): 205–12.
2. Forlino A, Cabral WA, Marini JC. New perspectives on osteogenesis imperfecta. Nat RevEndocrinol.2011;7(9):540-557.10.1038/nrendo.2011.81.
3. MariniJC, Bachinger H Petal. Osteogenesis imperfecta. Nat Rev Dis Primers. 2017;3:17052.10.1038/nrdp.2017.52.
4. Sillence DO, Rimoin DL, Danks DM. Clinical variability in osteogenesis imperfecta-variable expressivity or genetic heterogeneity. Birth Defects Orig Artic Ser.1979;15(5B):113-129.
5. Van Dijk FS, Sillence DO. Osteogenesis imperfecta: clinical diagnosis, nomenclature, and severity assessment. Am J MedGenetA.2014;164A (6):1470-1481.
6. Semler O, Garbes L, Keupp K, et al. A mutation in the 5’-UTR of IFITM5 creates an in-frame start codon and causes autosomal-dominant osteogenesis imperfect type V with hyperplastic callus. Am J Hum Genet. 2012;91(2): 349-357.10.1016/j.ajhg.2012.06.01.
7. Ishikawa Y, Bachinger HP. A molecular ensemble in the ER for procollagen maturation. Bio chim Biophys Acta. 2013;1833(11):2479-2491.10.1016/j.bbamcr.2013.04.008
8. Marini JC, Forlino A, Cabral WA, et al. Consortium for osteogenesis imperfecta mutations in the helical domain of type I collagen: regions rich in lethal mutations align with collagen binding sites for integrin sand proteoglycans. Hum Mutat.2007;28(3):209-221.10.1002/humu.20429
9. Morello R, Bertin TK, Chen Y, et al. CRTAP is required for prolyl 3- hydroxylation and mutations cause recessive osteogenesis imperfecta. Cell. 2006;127(2): 291 304.10.1016/j.cell.2006.08.039.
10. Bonafe L, Cormier-Daire V, Hall C, et al. Nosology and classification of genetic skeletal disorders: 2015 revision. Am J Med GenetA.2015;167A (12):2869-2892.10.1002/ajmg.a.37365.
11. Thomas IH, DiMeglio LA. Advances in the Classification and Treatment of Osteogenesis Imperfecta. Curr Osteoporos Rep. 2016;14(1):1-9.10.1007/s11914-016-0299-y.
12. Thompson EM. Non-Invasive Prenatal Diagnosis of Osteogenesis Imperfecta. Am J MedGenet.1993;45:201-206.10.1002/ajmg.1320450210.
13. Buisson O, Senat MV, Laurenceau N, Ville Y. Update on prenatal diagnosis of osteogenesis type II: An index case report diagnosed by ultrasonography in the first trimester. J Gynecol Obstet Bio l Reprod.2002;31:672-676.
14. Huang RP et al. Functional Significance of Bone Density Measurements in Children with Osteogenesis Imperfecta. The Journal of Bone and Joint Surgery (American). 2006:88:1324.10.2106/JBJS.E.00333.
15. MaromR, LeeYC, Grafe I & Lee B. Pharmacological and biological therapeutic strategies for osteogenesis imperfecta. American Journal of Medical Genetics Part C: Seminars in MedicalGenetics2016172367–383.10.1002/ajmg.c.31532.
16. TauerJT, Robinson ME & Rauch F. Osteogenesis imperfecta: new perspectives from clinical and translational research. JBMR Plus 20193 e10174 10.1002/jbm4.10174.
17. Bains JS, Carter EM, Cuthbertson D, et al. A multicenter observational cohort study to evaluate the effects of bisphosphonate exposure on bone mineral density and other health outcomes in osteogenesis imperfecta. JBMR Plus 20193 e10118.10.1002/jbm4.10118.
18. Kerry Dwan, Donald Basel Bisphosphonate Therapy for Osteogenesis Imperfecta. Cochrane Database Syst Rev. 2016 Oct;2016(10):CD005088doi:10.1002/14651858.CD005088.pub4.
19. Li LJ, Zheng WB, Li M. Effects of zoledronic acid on the vertebral shape of children and adolescents with osteogenesis imperfecta. Bone 2019127164–171. 10.1016/j.bone.2019.06.011.
20. Orwoll ES, Shapiro J, Veith S, Mullins MA, et al. Evaluation of teriparatide treatment in adults with osteogenesis imperfecta. Journal of Clinical Investigation 2014124491–498.10.1172/JCI71101.
21. Heike Hoyer-Kuhn, Christian Netzer, Oliver Semler Two years’ experience with denosumab for children with Osteogenesis imperfecta type VI. Orphanet J Rare Dis 2014 Sep 26;9:145.
22. Sinder BP, Novak S, Kalajzic I. Engraftment of skeletal progenitor cells by bone directed transplantation improves osteogenesis imperfecta murine bone phenotype. Stem Cells 2020 38530–541.10.1002/stem.3133.
23. Glorieux FH, Devogelaer JP, Winkle PJ. BPS804 anti-sclerostin antibody in adults with moderate osteogenesis imperfecta: a randomized phase 2a trial results. Journal of Bone and Mineral Research 2017 32 1496–1504. 10.1002/jbmr.3143.
24. Zieba J, Munivez E, Lee B. Fracture healing in collagen-related preclinical models of osteogenesis imperfecta. Journal of Bone and Mineral Research 2020 35 1132–1148.10.1002/jbmr.3979.
25. Song HR, Soma Raju VV, Kumar S, et al. Deformity correction by external fixation and/or intramedullary nailing in hypo phosphatic rickets. ActaOrthop2006;77:307–14.10.1080/17453670610046073.
26. Bailey RW, Dubow HI. Studies of longitudinal bone growth resulting in an extensible nail. Surg Forum. 1963; 14:455-8.PMID:1406569310.1302/0301-620X.82B1.9601.
27. Sofield HA, Millar EA. Fragmentation, realignment, and intramedullary rod fixation of deformity of the long bones in children: a ten-year appraisal. J Bone Joint Surg Am.1959;41(8):1371-91
28. Wilkinson JM, Scott BW, Bell MJ. Surgical stabilisation of the lower limb in osteogenesis imperfecta using the Sheffield Telescopic Intramedullary Rod System. J Bone Joint Surg Br.1998;80(6):999-1004.10.1302/0301-620x.80b6.8667.
29. Fassier F. Fassier-Duval telescopic system: how i do it? J Pediatr Orthop. 2017;37Suppl 2:S48-S51.10.1097/BPO.0000000000001024.
30. ChoTJ, Lee KS, Lee DY. Interlocking telescopic rod for patients with osteogenesis imperfecta. J Bone Joint Surg Am. 2007;89(5):1028-35. 10.2106/JBJS.F.00814.
31. Sarikaya I, Seker A, Guler B. Using a corkscrew-tipped telescopic nail in the treatment of osteogenesis imperfecta: a biomechanical study and preliminary results of 17 consecutive cases. J Pediatr Orthop B.2019;28(2):173-8.10.1097/BPB.0000000000000537.
32. Puvanesarajah V, Shapiro JR, Sponseller PD. Sandwich allografts for long-bone non unions in patients with osteogenesis imperfecta: a retrospective study. J Bone Joint Surg Am.2015;97(4):318-25.10.2106/JBJS.N.00584.
33. Li J, Rai S, Hong P. Rotational and translational osteotomy for treatment of severe deformity in hypophosphate mi crickets: A case report. Medicine 2020;99:3(e18425).10.1097/MD.0000000000018425.
34. Saldanha KA, Saleh M, Bell MJ, Fernandes JA. Limb lengthening and correction of deformity in the lower limbs of children with osteogenesis imperfecta. J Bone Joint Surg Br. 2004;86(2):259-65.10.1302/0301-620x.86b2.14393
35. To M, Gupta V, Chow W. Surgical management of long bone pseud arthrosis with severe limblength discrepancy in osteogenesis imperfecta. J Pediatr Orthop B. 2013;22(1):63- 9.10.1097/BPB.0b013e32834de542.
36. L H Gerber 1, H Binder, J Marini Effects of withdrawal of bracing in matched pairs of children with osteogenesis imperfect Arch Phys Med Rehabil 1998 Jan;79(1):46-51.
37. Metsemakers WJ, Roel, Nijs S. Risk factors for nonunion after intramedullary nailing of femoral shaft fractures: remaining controversies. Injury. Int J Care Inj. 2015;46:1601–7.10.1097/MD.0000000000016559.
38. Papakostidis C, Grestas A, Giannoudis PV. Femoral-shaft fractures and non unions treated with intramedullary nails: the role of dynamisation. Injury. Int J Care Inj. 2011;42:1353–61.DOI10.1016/j.injury.2011.06.024.
39. Paphon Sa-ngasoongsong, Tanyawat Saisongcroh, and Pornchai Mulpruek Using humeral nail for surgical reconstruction of femur in adolescents with osteogenesis imperfect World J Orthop. 2017Sep 18;8(9):735–740.doi:10.5312/wjo. v8. i9.735.
40. Wouter Alexander Goudriaan, Gerrit Jan Harsevoort, Guus Johannes Maria Janus European Journal of Trauma and Emergency Surgery (2020) 46:165–171 Incidence and treatment of femur fractures in adults with osteogenesis imperfecta: an analysis of an expert clinic of 216 patients.
41. Agarwal V, Joseph B. Non-union in osteogenesis imperfecta. J Pediatr Orthop. 2005;14(6):451–5.10.1097/01202412-200511000-00013.
42. Gamble JG, Rinsky LA, Bleck EE. Non-union of fractures in children who have osteogenesis imperfecta. J Bone Jt Surg Am. 1988;80(3):439–43.

How to Cite this Article:  Chhawra S, Jain R, Ahmed U, Agarwal N, Chaubey R, Singh G | Surgical and Medical Management of Deformity and Non-union with Implant failure of Femur in OI Type III | International Journal of Paediatric Orthopaedics | January-April 2022; 8(1): 35-42.

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A Rare Unreported Case of Comminuted Bicondylar Hoffa’s Fracture

Volume 7 | Issue 3 | September-December 2021 | Page: 23-25 | Gaurav Gupta, Qaisur Rabbi, Maulin Shah, Vikas Bohra
DOI-10.13107/ijpo.2021.v07i03.118

Authors: Gaurav Gupta MS Ortho. [1], Qaisur Rabbi D Ortho. [1], Maulin Shah MS Ortho. [1], Vikas Bohra DNB Ortho. [1]

[1] Department of Orthopaedic, OrthoKids Clinic, Ahmedabad, Gujarat, India.

Address of Correspondence
Dr Maulin Shah
Consultant Paediatric Orthopaedic Surgeon, OrthoKids Clinic, Ahmedabad, Gujarat, India.
E-mail: maulinmshah@gmail.com

Abstract

A coronal plane fracture of the distal femur (Hoffa’s fracture) is very uncommon and usually occurs as a consequence of high velocity trauma. Bicondylar involvement of coronal femoral fractures is even less common, especially in children. To our knowledge, this is the first case report of a comminuted bicondylar Hoffa’s fracture in the paediatric age group managed by low profile solid locking screws.
A fourteen-year-old boy was referred with complaints of pain, swelling and deformity of the left knee after a fall from a height of approximately 10 feet. Clinical examination of the left knee revealed swelling and effusion with a low-lying patella and multiple superficial abrasions. X-ray of the left knee revealed bicondylar Hoffa’s fracture (Letenneur type III, Salter Harris type III). Computed tomography (CT) revealed a comminuted non-conjoint bicondylar Hoffa’s fracture with a low-lying patella. The fracture was approached through an anterior midline incision. Extensor mechanism of the knee was found intact. Fracture fragments were reduced anatomically and held in compression with long ball-tipped clamps. Four screws were placed in an antero-posterior (two screws for each condyle) and two screws in a medio-lateral direction to achieve a strong fixation construct. The screws were kept entirely in the epiphysis. At 12 months follow-up, the patient was walking with a normal gait, and full extension and 90 degrees of flexion at the knee. Quadricepsplasty was performed at 1 year to improve knee flexion. At final follow up of 2 years, he had full range of knee motion with no functional limitation.
Keywords: Hoffa’s, Bicondylar, Adolescent, Comminuted, Quardricepsplasty

References

1. White, E. A., Matcuk, G. R., Schein, A., Skalski, M., Maracek, G. S., Forrester, D.M., & Patel, D. B. (2014). Coronal plane fracture of the femoral condyles: anatomy, injury patterns, and approach to management of the Hoffa’s fragment. Skeletal Radiology, 44(1), 37–43.
2. Harna B, Goel A, Singh P, Sabat D. Pediatric conjoint Hoffa’s fracture: An uncommon injury and review of literature. J Clin Orthop Trauma. 2017;8(4):353–354.
3. Lal H, Bansal P, Khare R, Mittal D. Conjoint bicondylar Hoffa’s fracture in a child: a rare variant treated by minimally invasive approach. J Orthop Traumatol. 2011;12(2):111–114.
4. Hoffa’s A. Lehrbuch der Frakturen und Luxationen. Stuttgart: Verlag von Ferdinand Enke. 1904; p. 451.
5. Ul Haq R, Modi P, Dhammi I, Jain AK, Mishra P. Conjoint bicondylar Hoffa’s fracture in an adult. Indian J Orthop. 2013;47(3):302–306.
6. Giotikas D1, Nabergoj M1, Krkovic M1. Surgical management of complex intra-articular distal femoral and bicondylar Hoffa’s fracture. Ann R Coll Surg Engl. 2016 Nov;98(8): e168-e170.
7. Kondreddi V, Yalamanchili RK, Ravi Kiran K. Bicondylar Hoffa’s fracture with patellar dislocation – a rare case. J Clin Orthop Trauma. 2014;5(1):38–41.
8. Mak W, Hunter J, Escobedo E. Hoffa’s Fracture of the Femoral Condyle. Radiology Case Reports [Online]. 2008; 3:231.
9. Xiao, K., Chen, C., Yang, J., Yang, D., & Liu, J. An attempt to treat Hoffa’s fractures under arthroscopy: A case report. Chinese Journal of Traumatology. 2018 Oct; 21(5): 308–310.
10. Thompson TC. Quadricepsplasty to improve knee function. J Bone Joint Surg Am. 1944;26:366–79.

How to Cite this Article:  Gupta G, Rabbi Q, Shah M, Bohra V | A Rare Unreported Case of Comminuted Bicondylar Hoffa’s Fracture | International Journal of Paediatric Orthopaedics | September-December 2021; 7(3): 23-25.

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