Indian made Telescopic nails in managing

osteogenesis imperfecta

Presenter : Dr. Puneeth K Pai

Co-Authors : Dr. Rudraprasad M S , Dr. Kiran Rajappa, Dr Abhishek
Bhasme, Dr. Abilash Srivatsav

Department of Paediatric Orthopaedics

Indira Gandhi Institute of Child Health, Bengaluru
 INTRODUCTION
• Osteogenesis imperfecta is a rare
heterogeneous group of inherited disorder
characterised by brittle bone frequent fractures
and skeletal deformities.

• Deformities of the long bones are common in

patients with osteogenesis imperfecta which
often require surgical correction.
• Telescopic nails has become the standard of treatment for stabilising long bones after
osteotomies especially in osteogenesis imperfecta and fibroud dysplasia
• As most of the telescopic nails are manufactured by foreign companies, they are overtly
expensive for the Indian population.

Bailey and Sheffield(1986) Fassier and Interlocking nails(TLN

Dubow(1963) Dual(2000) -2005)
 • Indian replicas of the telescopic nails are available and is being widely
used in the management of osteogenesis imperfecta deformities.

Generation I
Principles of nailing in OI
• Selection of type of nail - Solid vs Telescopic- Need for arthrotomy
• Diameter of the nail
• Length of the nail
• Method of osteotomy- Open vs percutaneous
 Solid vs Telescopic nails
• Solid nails- Rush pins, Square nails, K-wires.
• Telescopic nails- Bailey-Dubow, Sheffield, Fassier-Duval, Interlocking telescopic
nail.

All telescopic rods have

1.Female component - Hollow rod engaging the proximal cortex

2.Male component- solid rod engaging the distal cortex.

 DIAMETER OF RODS

• ALL SIZE RODS SHOULD BE AVAILABLE!!!

• PREOPERATIVE ASSESSMENT - ANTERO POSTERIOR DIAMETER is decisive - BONES
ARE RIB SHAPED

• Best decision is taken INTRA-OPERATIVELY

• AVOID OVER REAMING- Idea is to use nail as an internal splint

Length of nail
• Use of preoperative templates to assess the length
• Osteotomies to be taken into consideration

• Measure L- distance between Greater trochanter and the distal femur growth
plate
• Male length is L + (10-15mm)
• Female length is L-7 mm
Method of osteotomy

Open osteotomy

Adv
Easier to ream at the isthmus

Disadv
Extensive soft tissue dissection
Percutaneous osteotomy

• Advantage
Minimal soft tissue
dissection

• Disadv
1.Need for extensive
fluoroscopy
2.Difficult to ream the
isthmus
Bailey-Dubow rod(1963)

50-57.9%
Complications of Bailey -Dubow
SHEFFIELD ROD(1986)

50%
 FASSIER-DUVAL ROD(2000)

• Anchorage achieved proximally and distally by “screw-in” fixation.

• Adv-
1. Single entry - proximal
2. No need for arthrotomy

Re-operation rate was 13%

38% in a study on 13
24 patients
 Interlocking Telescopic Nail(2005)
• Female same as Sheffield system
• Male has distal pin for fixation in the epiphysis
• Revision rate 9 % at 2 years and 28 % at 3years
• Proximal migration 12.5%
 OBJECTIVES

To determine the efficacy of the Indian telescopic nails in treatment of

osteogenesis imperfecta and to identify the complications associated
with them.
 Material & Method
• Retrospective analysis conducted at IGICH , Bangaluru.
• Children with osteogenesis imperfecta who have
undergone telescopic nailing for lowers limb deformity
and have a minimum follow-up of two years where
included in the study.
• Telescopic nailing using the Indian telescopic nails done as
per standard technique.
• Post operatively the limb was protected in a cast/ slab for six weeks followed by
bracing till union at the least.

• All children had received bisphosphate therapy.

• They were followed up at a regular interval of one month for the first three
months, then once in four months.

• During each follow-up Clinical and Radiographic examination were conducted to

identify any recurrence of deformity, refracture, failure of implant or any other
associated complications related to the implant or the condition.
 RESUL
TS
• 32 patients (82 extremities) where included Number of patients

in the study.

• The mean age of the study population was

eight years from 2013-2021
38% Male
Female
• All fractures following osteotomies united by
63%
8 weeks.

• The mean follow-up was three years nine

months.
 Failure of Telescopy
• Failure to telescope /loss of distal femur fixation was observed
in 52.2% of the cases .
1.5YRS 3YRS
• Anterior cortex breach by the male rod was observed in 7.6% of the cases
 • Bending of the nail at Junction was seen in 10.8 % of the cases
and 6.5% of them eventually had a re-fracture

Revision of
telescopic nails
was required in
46%.
 Why Local ?!
• The Indian nails cost approximately about 5% of the cost of other
available imported telescopic nails.
 Article Journal Year Number of patients Complications Re-surgery rate

1.Experience of bailey Dubow rods in European 2000 63patients- (183 limbs) Rod migration-7.9% 57.1%
children with OI journal of Knee penetration-7.9%
pediatric T piece detachment-10 %
surgery

2.Use of Sheffield rod in Osteogenesis Journal of 2011 22 patients(64 limbs) Rod disengagement due to 50 %
imperfecta - A 19 year follow-up bone and growth -10%
joint surgery

3.Fassel-duval rodding in children with Journal of 2011 60 patients (101 limbs) Nonunion -12.5% 35%
osteogenesis imperfecta. child Refracture- 10%
orthopedics

4. Combined two-centre experience Bone and 2020 34 children(72 limbs) Failure to telescope 10% 25%-50%
of single- entry telescopic rods joint journal Cut out -10%
identifies characteristic modes of
failure

5. Our study Un-published 2013- 32 patients (82 limbs) Rod bending -10.8% 46%
2020 Anterior cortex - 7.6%
 CONCLUSION

• Indian telescopic nails are affordable and it gives a good short-term result.

• Re-operation rates are low with FD rods and its replicas.

• But long-term results may vary and there is a need for biomechanical studies of
the Indian mimics of FD nails in order to improve the design and quality of the
nails for better functionality.