EXPERIENCE WITH THE FASSIER-DUVAL TELESCOPING ROD: FIRST 24 CONSECUTIVE CASES WITH A MINIMUM OF 1 YEAR FOLLOW UP

Background

The new Fassier-Duval Telescopic IM System (FD-rod) has the advantage of a single entry point over the traditional telescopic rods such as the Bailey-Dubow or Sheffield rods. Although encouraging early results were presented by François Fassier, there is no formal publication in the literature as yet.

Methods

The first 24 consecutive cases (age 1.5-12.5 years) with a minimum of 1 year follow-up (1-2.4 years) after femoral and/or tibial FD-rods were reviewed to assess complications involving migration, non-telescoping, joint intrusion, infections and re-operation rates in patients with Osteogenesis imperfecta (OI, 15 cases), congenital tibial pseudarthrosis (CPT) in Neurofibromatosis Type1 (NF1, 2 cases), and Epidermal Naevus syndrome (1 case). In 6 cases of patients with Hypophosphataemic Rickets FD-rods were combined with an Ilizarov frame.

Results

The OI patient group had a 13% re-operation rate (2/15) for proximal rod migration and a 40% complication rate (6/15 cases): rod migration and limited telescoping (5), intra-operative joint intrusion (1). There were no infections. All NF1 CPT (2) and Epidermal Naevus syndrome (1) cases required several re-operations for non-union, loss of fixation, shortening (negative telescoping), migration and/or joint intrusion – mainly due to the severe underlying pathology with insufficient longitudinal or torsional stability and diminished healing capacity.

The 6 cases with Hypophosphataemic Rickets, combined with Ilizarov frame fixation, had a 50% complication rate (3/6) and a 17% re-operation rate (1/6): 2 cases did not telescope and 1 case of peroneal neuropraxia required neurolysis.

Conclusion

In our experience the technique of using Fassier-Duval rods is demanding and associated with some intra- and post-operative pitfalls. We are happy to continue its use in OI patients when there is longitudinal stability and sufficient bone healing. However, in circumstances of insufficient stability and bone healing potential, further stabilisation e.g. with an Ilizarov frame may be beneficial.