Telescopic Rodding in Combined Technique After Transphyseal Elastic Nailing in a Boy with Type IV Osteogenesis Imperfecta

There are some indications for sliding titanium flexible intramedullary nailing (FIN) in selected cases, such as in severe osteogenesis imperfecta (OI) patients under the age of four to six, with narrow medullary canals and severe comorbidities. The FIN is considered as a less invasive and salvage procedure compared to telescopic rodding but is a temporary option. Because no telescopic rod available in our country before 2017, sliding FIN was the only method to manage long bone pathology in children with severe and moderate-to-severe types of OI. This is a case of a boy with type IV OI, initially treated with FIN at the age of 3.5 years in 2015. During the period from 2018 to 2021, elastic nails were replaced by titanium telescoping rods (TTR). These are not Fassier-Duval rods. Simultaneous surgery was performed for bilateral femurs and left tibia. Only telescopic rod without external fixation was used for right tibia. The main surgical indications for implant replacement were fractures and deformities. We present and discuss surgical techniques applied in this case, pitfalls, and mid-term results.