The problems of surgical treatment of children with vitamin-D-resistant rickets

Purpose. To study the efficiency of combined osteosynthesis use for treatment of lower limb deformities in children with vitamin D-resistant rickets. Materials and Methods. The authors evaluated the recurrence incidence for long bone deformities of the lower limbs, and revealed the morphological features of the bones based on analyzing 369 case reports reflecting the results of surgical treatment of multiplanar deformities in patients with vitamin D-resistant (hypophosphatemic) rickets. Results. Osteosynthesis with the Ilizarov fixator after correcting osteotomy is the most reliable option of fixation for such patients, though the periods of fixation still been significant (up to 160 days), and deformity recurrences in the growing child observed in 69.5 % of cases. The combined osteosynthesis using the Ilizarov fixator with intramedullary reinforcement by wires with bioactive coating reduces the risk of re-deformities up to 20 %, and the fixation periods using the external fixator 2-3-fold decrease. Re-deformities develop at the level of new parts of bone metaphysis formed during growth. Conclusion. The success of deformity treatment in patients with diabetes phosphaticus largely depends not only on the accuracy of limb axis biomechanical correction and the technique of bone fragmental fixation, but also on the real possibility of controlling the rate of reparative process and influencing the regenerated bone quality through the bioactive coating of bone implant. Surgical treatment should be accompanied by intense conservative treatment influencing the disease pathogenesis (the increased doses of vitamin D and its metabolites, the preparations with vitamin D-activity, calcium and phosphorus preparations, Somatotropin and Calcitonin if necessary).