Polysegmental distraction osteosynthesis in combination with a telescopic transphyseal rod for Ollier's disease

Introduction The use of combined techniques for long bone lengthening in patients with Ollier disease is of interest due to issues of both external fixation time reduction and improvement in the strength properties of the lengthened bone. The uniqueness of the presented clinical case is simultaneous femur and tibia lengthening over a titanium telescopic rod in the femur and tibia combined with external osteosynthesis and osteotomies. The purpose of this study is to demonstrate the stages and results of polysegmental bone lengthening in a child with Ollier disease using a technique combining the Ilizarov fixator and a titanium telescopic rod. Material and methods This clinical case is a five-year-old patient with Ollier disease without comorbidities, but with a significant discrepancy in the length of the lower limbs, impaired weight-bearing ability, and impaired gait biomechanics. Surgical treatment included multisegmental femur and tibia lengthening over a titanium telescopic rod inserted retrograde into the femur and antegrade into the tibia, simultaneous osteotomies and placement of a wire-and-halfpin external fixator. Results Exceptional data were obtained confirming the possibility of the titanium telescopic rod extension during distraction by more than 20 % without locking or loss of fixation of the threaded parts in the epiphyses. The elongation amounted to 11.4 cm (femur: 5.8 cm; tibia: 5.6 cm). The overall external fixation index was 12.02 days/cm. At a 12-month follow-up after dismantling the Ilizarov apparatus, growth of the elongated bones and telescoping of the femoral rod continued. Discussion This combined technique is consistent with the current concept of extended telescopic reinforcement in children with genetic diseases. The divergence of the titanium rod components both during the distraction period and during the first year after completion of limb lengthening demonstrates the feasibility of this combination and the reliability of using a telescopic titanium rod. This study demonstrates for the first time that rapid divergence does not predispose to locking of titanium rods and continues with growth. Conclusion This case demonstrates the effectiveness of using a combination of telescopic intramedullary titanium rods and external fixation for simultaneous lengthening of two adjacent segments in a child with Ollier disease. The findings on further natural growth of the lengthened segments along with telescoping of the rod are unique.