Surgical treatment of multidimensional deformities of lower limbs before closure of the growth plate in children with rachitic diseases
Keywords:D-resistant rickets, D-dependent rickets, rickets, deformities of the lower extremities in children
Background. The purpose was to improve the results of surgical treatment for multidimensional deformities in children with open growth plates in rachitic diseases. Materials and methods. In the State Institution “Institute of Traumatology and Orthopedics of the National Academy of Medical Sciences of Ukraine” from 2013 till 2019, we have treated 6 patients aged 3 to 9 years with vitamin D-dependent (2) and vitamin D-resistant (4) rickets with multidimensional deformities of lower limbs that significantly affected gait function and lower limb biomechanics. In order to correct the deformities of the lower extremities, all patients underwent segmental corrective osteotomies of every segment of lower limbs (24). Fixation was performed by an intramedullary telescopic rod, which gave the possibility to fix the limb after surgery, without affecting the further growth of the child. In 2 cases, a patented rod of Ukrainian production was used, in four cases — a prototype of Fassier-Duval intramedullary telescopic rod. Results. In operated patients, walking and support function was significantly impaired prior to treatment, after surgery with the use of intramedullary telescopic rods, the function of gait and support is restored, multidimensional deformities are eliminated. All patients underwent conservative treatment for bone metabolic disorders. In all cases of osteotomy, healing occurred at proper time, the growth of the femur and tibia is not disturbed in length, moving of the intramedullary structures is satisfactory, no patient had recurrent fractures and deformities of the lower extremity long bones during the observation period, no migration of the elements of metal structures was detected. The maximum postoperative follow-up period in our patients was 1.5 years from the start of surgery. Conclusions. In the surgical treatment for multidimensional deformities of the lower extremities, we recommend using multilevel osteotomies with metal osteosynthesis by intramedullary telescopic rod, which allows for a one-time correction of rickets and helps avoid the damage to the growth plate.
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Гук Ю.М., Марциняк С.М., Зима А.М., Сивак М.Ф., Чеверда А.І., Олійник Ю.В. Спосіб лікування деформації стегнової кістки при системних захворюваннях скелету у дітей. Патент на корисну модель № 98274 від 27.04.2015. Бюлетень про видачу патенту № 8 від 27.04.2015.
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Pat. 6524313 B1 US, A61B 17/72; A61B 17/68; A61B 017/72. Intamedullary nail system / Fassier F., Duval P., Dujovne A.; Assignee Pega Medical (St-Leonard, CA). — No US 09/671,164; filed 28.09.2000; published 25.02.2003.
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