Sometimes children with Osteogenesis Imperfecta undergo rodding surgery to
help provide strength to their long bones (arms and legs). Rodding surgery involves inserting a metal rod into the bone to
give it support, the rod acts as an internal splint. If a particular bone is bowed and/or has fractured repeatedly many parents
begin thinking about having the bone rodded.
In the surgery the bone is cut in one or more places, this is called an osteotomy,
and allows the bone to be straightened. Then a rod is inserted into the bone. Often times once a bone is straightened and
has the added support of the rod it is able to tolerate more weight and movement than in the past. Many parents find that
once a bone is rodded it does not break as easily. The rod may not always prevent the bone from breaking, but it will act
as an internal splint that holds the bone in place, keeping it aligned, and greatly reducing the pain caused by a fracture. Most
often a cast is not needed.
When to have rodding surgery depends on a number of things. If the bowing
in a particular bone is greater than 30 degrees most doctors agree that it is not a question of "if" the bone will break,
but rather "when". If the bowing is severe enough it may also interfere with a childs ability to learn to push up, crawl or
stand. And in other instances a bone may
fracture repeatedly, leading to a vicious cycle of a fractured bone being splinted, during which time it becomes weaker because
of inactivity, then after it is healed it quickly fractures again which requires more splinting, leading to even greater
weakness, etc.. Rodding surgery can help break this cycle and allow a child to use their limbs with much greater confidence.
Rodding surgery can either be planned or happen emergently because of
a bad fracture. If your child has moderate to severe bowing or has had repeated fractures of the same bone, it is a good thing
for the parents to talk with a doctor about rodding. If the surgery can be done locally sometimes the doctor and parents come
up with a plan to wait for the next fracture and then rod at that time so as to minimize the childs "down time". If
the surgery will not be done locally then more often this requires planning the surgery in advance.
In
the past many surgeons did not want to rod very young children, but this has changed dramatically in the past 5-10 years because
of Pamidronate treatments. Pamidronate can dramatically decrease bone pain (a general achiness that causes pain and prevents
a child from wanting to move as much), decrease the fracture rate, and increases bone density. As a result babies
and children with OI are moving more and reaching major milestones (rolling, sitting, crawling, standing, walking,
etc) earlier than in the past. And because Pamidronate increases bone density the quality and size of bone that
the surgeon has to work with is often greatly improved. For many
children with OI, Pamidronate treatments, rodding surgery and physical therapy provide a very powerful combination,
helping the child to reach their greatest potential for function and mobility.
What types of Rods are available?
There are two types of rods, telescoping and non-telescoping. The rods are typically named for the person/s
who developed them. The following is a brief description of three different rods that are often used in rodding
surgeries.
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The Fassier-Duval rod is the newest of the
rods. It is a telescoping rod and is seems to offer the greatest advantages. The procedure to insert the rods is much less
invasive than procedures for other rods, this equates to less blood loss, smaller incisions, quicker recover time and fewer
complications.The Fassier-Duval rod requires only 3 weeks of immobilization in long leg splints, rather than a hip spica (half
body cast).
| Fassier-Duval Rods ( expanding rods). |
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