Effects of a telescopic intramedullary rod for treating patients with osteogenesis imperfecta of the femur.

PURPOSE: To introduce a new model of telescopic intramedullary rod (TIR), evaluate its effects on treating patients presenting with moderate and severe osteogenesis imperfecta (OI) and to compare the findings with those of other telescopic rods. METHODS: A total of 21 patients (nine girls and 12 boys; mean age at first operation, 6.6 years, 1.52 to 13.18) who underwent 52 femoral operations were monitored during a mean of 9.96 years (3.39 to 14.54). Patient characteristics, telescoping rod capability and its complications were examined. RESULTS: According to the Sillence classification, we investigated one patient with type I, nine with type III and 11 with type IV OI. Revision rates at up to five years (36%) were inferior to those found for the Fassier-Duval rod (46%). The main cause of revision was fracture (15 patients), followed by rod migration (nine), and infection (two). The rod exhibited higher telescopic capacity in boys than girls. Type III most commonly required an operation; the age group with the highest number of procedures was five to ten years. Male migration was the main cause of rod migration. CONCLUSION: The TIR has a satisfactory cost-benefit ratio with less complication rates and low production costs. The TIR is a feasible alternative to the commonly used Fassier-Duval rod. LEVEL OF EVIDENCE: IV.

Fraturas do terço distal do rádio na criança / Fractures of the distal third of the radium in children

As fraturas do antebraço na criança são freqüentes e, dentre estas, as mais comuns são as que acometem seu terço distal. De evolução normalmente favorável, poucos cuidados demandam além da correta imobilização, que pode ser ou não precedida de redução. Algumas vezes, no entanto, podem sofrer uma deformidade dorsal t¡pica, que, dependendo do grau de angulação volar, leva à indicação de procedimentos corretivos sob anestesia, como a caloclasia e redução, ou a redução aberta ou fechada seguida de fixação. Os autores discutem os mais conhecidos fatores causais relacionados com o aparecimento do desvio dorsal e sugerem a poss¡vel influência mecânica do comprimento relativo da ulna em relação ao rádio, com especial enfoque à articulação radioulnar distal. Recomendam maior atenção nas fraturas do terço distal do antebraço, especialmente nas fraturas "isoladas" do rádio nos pacientes portadores da variante ulna minus, em que permanece ¡ntegra a articulação radioulnar distal.