Journal of Pediatric Orthopaedics - 2026-06-15 - Journal Article
Does the Location of the Distal Tibial Epiphyseal Fixation Affect Rod Failure in Children With Osteogenesis Imperfecta?
Wang K, Callister J, Wallace M
Topics
Key Takeaway
Lateral distal tibial epiphyseal rod placement increases failure-to-telescope odds by 2.71-fold (OR 2.71; 95% CI 1.48–5.05) in pediatric OI patients undergoing Fassier-Duval tibial rodding.
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Summary
This study asked whether distal tibial epiphyseal rod position on AP and ML axes predicts failure to telescope in pediatric OI patients treated with Fassier-Duval rods. In 452 tibial rodding procedures across 102 patients, multivariable logistic regression identified lateral ML placement (OR 2.71, P=0.001) and younger age (OR 0.90 per year, P<0.001) as independent predictors of the 39.6% overall failure-to-telescope rate. Central AP positioning trended toward protection but was not significant on multivariate analysis.
Key Limitation
The study does not report follow-up duration or time-to-failure data in sufficient detail to determine whether positioning effects persist across growth phases or are concentrated in the early postoperative period.
Original Abstract
BACKGROUND
Fassier-Duval (FD) rods are commonly used for tibial stabilization in children with osteogenesis imperfecta (OI). However, failure to telescope remains frequent, and the impact of rod positioning and patient age on outcomes remains poorly defined.
METHODS
A retrospective review of 452 tibial FD rod placements in 102 pediatric OI patients was performed. Rod position on the anteroposterior (AP) and mediolateral (ML) axes was determined using postoperative radiographs. Failure to telescope was assessed as the primary outcome. Secondary outcome was time to failure. Statistical analysis included chi-squared, linear regression, and multivariable logistic regression.
RESULTS
The failure to telescope rate was 39.6%. Lateral placement significantly increased the odds of failure (OR: 2.71; 95% CI: 1.48-5.05; P=0.001), whereas medial placement showed a nonsignificant trend (OR: 1.94; P=0.088). Central positioning was associated with the lowest failure rate, although AP positioning was not a significant predictor on multivariate analysis. Younger age was significantly associated with failure (OR: 0.90; 95% CI: 0.85-0.95; P<0.001).
CONCLUSIONS
Intermediate rod placement on the AP view significantly reduces the risk of telescoping failure in FD-stabilized tibiae in children with OI. Younger age is a strong predictor of failure, likely due to anatomic challenges. Emphasis on optimal rod placement is warranted to improve outcomes and reduce revision rates.
LEVEL OF EVIDENCE
Level III, retrospective cohort study.