Bone Abstracts

The objectives of this talk are to discuss the assessment, management, and operative indications of upper limb deformities in osteogenesis imperfecta (OI). The indications for operative treatment of upper limb deformities have evolved with the advent of improved medical treatment (bisphosphonates) and long bone rodding in the lower extremities. Long bone rodding in the lower extremities has become standard treatment in OI. However, upper limb deformities are less commonly treated surgically due to lack of clear indications, limited surgical experience with these challenging deformities and the false impression that the upper extremities are non-weight bearing.

Children with moderate to severe OI types have become more mobile due to improved medical and surgical treatment and may require the use of their upper limbs to initiate and maintain walking as well as for activities of daily living. Ambulatory patients with moderate to severe OI use walking aids and therefore will be applying increase weight on their upper limbs for support. As such, upper limb deformities and fractures have become a more significant problem and can impact function and quality of life in these patients.

Upper extremity deformities in OI are becoming an increasing problem and are surgically more challenging to treat due to the size of the bones and the extent of the deformities. The proximal upper limb (i.e., the humerus) is more commonly addressed surgically in upper limb deformities. Deformities of the proximal humerus are typically easier to correct than those in the distal third of this bone. A common complication of osteotomies in the distal third of the humerus is non-union with development of a pseudarthrosis. Surgical techniques for rodding the humerus as well as methods to avoid and treat a variety of complications will be discussed. The need for additional fixation in humeral deformity correction will also be addressed. The presentation will then examine deformities of the elbow, including radial head dislocations and the conservative and surgical treatment options available to improve elbow function. Finally, indications for surgical correction of forearm deformities will be addressed along with guidelines for treatment of forearm deformities in OI.

Disclosure: Educational consultant: Smith and Nephew.