Coxa vara and valga correction on telescopic nails in osteogenesis imperfecta

Abstract

Background: Varus or valgus deviations of the femoral neck in Osteogenesis Imperfecta had been an ignored chapter because classic correction procedures were applied in medical practice with unsatisfying results. Until the use of telescopic rods, coronal deviations remained unsolved and the distal configuration of the proximal femoral extremity remained uncorrected or partially corrected which required extensive use of wheel chair or bed immobilization of the patient. The concomitant correction of complex deformities, coxa vara/valga and femoral integrated configuration, has been a progress which allowed patients to walk with or without support. Purpose: The purpose of this study is to present the Burnei’s technique, a therapeutic alternative in deformity corrections of the varus or valgus hip in children with Osteogenesis Imperfecta. Material and methods: The paper is a retrospective study performed in a single center which analyses Burnei's technique and other procedures described in literature. The content of the paper is based on a 12 years experience, on a series of 51 patients with Osteogenesis Imperfecta out of which 10 patients (13 hips) presented frontal plane deviations of the femoral neck. Results: All patients with Osteogenesis Imperfecta which presented coxa vara or valga were submitted to investigations with the purpose to asses the possibility of extending the surgical intervention to the distal segment of the lower limb, to establish the association of severe deformities of the proximal extremity of the femur and the necessity of postoperative intensive care. Burnei’s technique: The operation was first performed in 2002. A subtrochanteric osteotomy is made in an oblique cut, from the internal side to the external side and from proximal to distal for coxa vara, or using a cuneiform resection associated with muscular disinsertions. Only telescopic rods are used for osteosynthesis. Conclusions: Burnei’s technique is simple, it corrects concomitant with Sofield-Millar the varus and valgus deviations. Even though only a telescopic rod is used, no stress fractures were seen postoperative, deviation recurrence or assembly loss.