Fassier-Duval Rod Failure: Is It Related to Positioning in the Distal Epiphysis?
Child
Child, Preschool
Epiphyses
/ surgery
Equipment Failure Analysis
Female
Fractures, Bone
/ diagnosis
Humans
Male
Orthopedic Procedures
/ adverse effects
Osteogenesis Imperfecta
/ diagnosis
Outcome and Process Assessment, Health Care
Prosthesis Fitting
/ adverse effects
Radiography
/ methods
Retrospective Studies
United States
Journal
Journal of pediatric orthopedics
ISSN: 1539-2570
Titre abrégé: J Pediatr Orthop
Pays: United States
ID NLM: 8109053
Informations de publication
Date de publication:
Sep 2020
Sep 2020
Historique:
pubmed:
8
2
2020
medline:
12
1
2021
entrez:
8
2
2020
Statut:
ppublish
Résumé
The relationship between Fassier-Duval (FD) rod placement and rod failure rates has not previously been quantified. Retrospective review was conducted on patients with osteogenesis imperfecta treated with FD rods between 2005 and 2017. Age at first surgery, sex, Sillence type of osteogenesis imperfecta, bisphosphonate treatment, location of rod (side of body and specific bone), and dates of surgeries, radiographs, and rod failures were collected. C-arm images determined rod fixation within the distal epiphysis at the time of surgery. C-arm variables included rod deviation (percent deviation from the midline of the distal epiphysis) and anatomical direction of deviation (anterior/posterior and medial/lateral). X-ray images were examined for rod failure, which was defined as bending, pulling out of the physis, protrusion out of the bone, and/or failure to telescope. Cox proportional hazards regression models were used to compare failure rates with location of placement within the distal epiphysis allowing for clustering of the data by side (left or right) and bone (femur or tibia). The cohort was 13 patients (11 female individuals and 2 male individuals) with a total of 66 rods and 75 surgeries. Mean time from the first surgery to the last follow-up visit was 8.9 years (SD=5 y). There was a 7% increase in hazard of failure per 1-mm increase in antero-posterior (AP) deviation [hazard ratio (HR), 1.07; 95% confidence interval (CI), 1.01-1.14; P=0.029)]. Similarly, there was a 9% increase in hazard of failure for every 1-mm increase in lateral deviation (HR, 1.09; 95% CI, 1.01-1.18; P=0.019). A 12% increase in hazard of failure per 10% increase in deviation from the midline for both AP and lateral radiograph views was also found, although this was only statistically significant for lateral deviation on the AP radiograph view (HR, 1.12; 95% CI, 1.01-1.25; P=0.030). FD rod placement within the distal epiphysis has significant impact on increasing rod survival. Level III-therapeutic study.
Sections du résumé
BACKGROUND
BACKGROUND
The relationship between Fassier-Duval (FD) rod placement and rod failure rates has not previously been quantified.
METHODS
METHODS
Retrospective review was conducted on patients with osteogenesis imperfecta treated with FD rods between 2005 and 2017. Age at first surgery, sex, Sillence type of osteogenesis imperfecta, bisphosphonate treatment, location of rod (side of body and specific bone), and dates of surgeries, radiographs, and rod failures were collected. C-arm images determined rod fixation within the distal epiphysis at the time of surgery. C-arm variables included rod deviation (percent deviation from the midline of the distal epiphysis) and anatomical direction of deviation (anterior/posterior and medial/lateral). X-ray images were examined for rod failure, which was defined as bending, pulling out of the physis, protrusion out of the bone, and/or failure to telescope. Cox proportional hazards regression models were used to compare failure rates with location of placement within the distal epiphysis allowing for clustering of the data by side (left or right) and bone (femur or tibia).
RESULTS
RESULTS
The cohort was 13 patients (11 female individuals and 2 male individuals) with a total of 66 rods and 75 surgeries. Mean time from the first surgery to the last follow-up visit was 8.9 years (SD=5 y). There was a 7% increase in hazard of failure per 1-mm increase in antero-posterior (AP) deviation [hazard ratio (HR), 1.07; 95% confidence interval (CI), 1.01-1.14; P=0.029)]. Similarly, there was a 9% increase in hazard of failure for every 1-mm increase in lateral deviation (HR, 1.09; 95% CI, 1.01-1.18; P=0.019). A 12% increase in hazard of failure per 10% increase in deviation from the midline for both AP and lateral radiograph views was also found, although this was only statistically significant for lateral deviation on the AP radiograph view (HR, 1.12; 95% CI, 1.01-1.25; P=0.030).
CONCLUSIONS
CONCLUSIONS
FD rod placement within the distal epiphysis has significant impact on increasing rod survival.
LEVEL OF EVIDENCE
METHODS
Level III-therapeutic study.
Identifiants
pubmed: 32032215
doi: 10.1097/BPO.0000000000001513
pmc: PMC7415471
mid: NIHMS1549663
pii: 01241398-202009000-00031
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
448-452Subventions
Organisme : NCRR NIH HHS
ID : KL2 RR025779
Pays : United States
Références
Iowa Orthop J. 2006;26:37-40
pubmed: 16789446
J Clin Endocrinol Metab. 2013 Aug;98(8):3095-103
pubmed: 23771926
J Child Orthop. 2011 Jun;5(3):217-24
pubmed: 22654983
Curr Opin Pediatr. 2008 Feb;20(1):52-7
pubmed: 18197039
J Med Life. 2015 Oct-Dec;8(4):563-5
pubmed: 26664490
J Pediatr Orthop. 2019 May/Jun;39(5):e392-e396
pubmed: 30589679
J Pediatr Orthop. 2015 Mar;35(2):178-84
pubmed: 24919136
J Pediatr Orthop. 2017 Sep;37 Suppl 2:S48-S51
pubmed: 28799995
J Pediatr Orthop. 1988 Nov-Dec;8(6):645-9
pubmed: 3056970
Lancet. 2016 Apr 16;387(10028):1657-71
pubmed: 26542481
J Child Orthop. 2018 Feb 01;12(1):97-103
pubmed: 29456761
Lancet. 2004 Apr 24;363(9418):1377-85
pubmed: 15110498
J Pediatr Orthop. 2016 Sep;36(6):656-60
pubmed: 25929780
J Pediatr Orthop. 2011 Jun;31(4):458-64
pubmed: 21572286
Arch Orthop Trauma Surg. 1998;117(4-5):240-5
pubmed: 9581251
Clin Orthop Relat Res. 1990 Feb;(251):254-62
pubmed: 2295183
J Bone Joint Surg Am. 2011 Nov 2;93(21):1994-2000
pubmed: 22048094