Revision of Telescoping Rod and Plate Complicated with Nonunion and Metallosis in a Girl with Osteogenesis Imperfecta Type VIII

This is a case of a 13-year-old girl with Type VIII osteogenesis imperfecta (OI), who required care for femur nonunion and problems with the Fassier-Duval (FD) rod and other local hardware. A revision surgery featuring hardware removal and fixation with intramedullary pins and an external fixator was successful in achieving anatomic union. Telescopic rodding is recognized as the most successful system for long-lasting intramedullary osteosynthesis dedicated to correction of long bone deformities in children with OI. The major limitation of any intramedullary telescopic system is rotational and longitudinal instability. The combined use of telescopic rods and locking plates with screw fixation is aimed to prevent secondary torsional deformations. However, this method does not enable axial loading on the operated site of the bone. It mandates a second operation to remove the plate after bone union. This combined approach also excludes the possibility of minimally invasive percutaneous osteotomies. Further, the proximity of dissimilar metals may lead to galvanic reaction injuring tissues and compromising hardware. It is well-known, the common metallurgic wisdom cautions against association of dissimilar metals for osteosynthesis in a biologically active environment. This impermissible situation results in corrosion that compromises the implants and leads to aseptic loosening, implant failure, or adverse biological reaction, e.g., aseptic inflammation, in host tissue.