Long term complications of conservative treatment of lower leg fractures in children with osteogenesis imperfecta

REN Xiu-zhi; CHEN Mei; FANG Feng-ling; LIU Jun-long; DOU Cong-hui

doi:10.3969/j.issn.2095-252X.2015.10.007

Abstract：Objective To analyze long term results and complications of conservative treatment for lower leg fractures in children with osteogenesis imperfecta.Methods The series X-ray iflm of 1100 patients admitted in our hospital from September 2001 to July 2014 were analyzed retrospectively. According to Sillence classiifcation, there were 376 cases of type I, 320 cases of type III, and 404 cases of type IV. Epiphyseal closure occurred in 437 cases, among which 45 cases ( 30 males and 15 females ) had long term series of X -ray iflm and were treated conservatively for the recurrent fractures of the lower legs ( e.g. traction, splints, spica cast ). The average age was 17 years old ( range: 13-34 years ). Sillence classification: type I 2 cases, type III 20 cases, type IV 23 case. The number of fractures and the immobilization time of each fracture were analyzed. Functions of the lower leg, the alignment and the radiological results of the femur and the tibia at the latest follow up were recorded.Results Recurrent fractures were treated by conservative method in 45 cases. The mean period of immobilization was 50 days ( range: 30-90 days ). Most fractures healed, while 30 cases have pseudarthrosis and 27 cases showed premature epiphyseal closure. For those legs immobilized by traction or cast without any weight bearing and the time of immobilization was longer than 6 months due to recurrent fractures, the X-ray iflm showed progressive process of osteoporosis. Radiologically, the bone became slim, the medullary canal closed, the joint swelled compared with the slim diaphysis. If the medullary canal existed, the cotex bone was usually thin and the multiple level deformity was common. At the latest follow up, 5% patients were completely bedridden; 30% needed wheelchair; 35% could walk in short distance with the aid of crutches; 30% could walk independently; although some of them had abnormal gait. Unfortunately, 30% cases could not receive any orthopedic procedures because the bone was too slim to be ifxed.Conclusions Although the fracture of the lower leg in children with osteogenesis imperfecta usually can heal by conservative treatment, recurrent fracture and conservative treatment will lead to bad long term functional and radiological results. Timely osteotomy and intramedullary pin ifxation are recommended to restore the weight-bearing function to avoid adverse effects on bone growth.