09/05/2014    

QUERIES (CLINICAL)

Query: Osteogenesis Imperfecta Patient

 

I'm planning on doing surgery on a 65 y/o female patient with osteogenesis Imperfecta w/ fibrous dysplasia. I would like advice from colleagues experienced with these patients. Her chief complaint is B/L foot pain - painful HAV, painful IPK sub-met heads, and painful hammertoes. She has a history of multiple bone fractures in her body, but no prior foot fractures.

 

Osteogenesis Imperfecta

 

My thoughts are to avoid osteotomy/fusion procedures (i.e., hardware) due to risk of fracture and non-union. Thus, I'm thinking of performing a Keller, PIPJ arthroplasty 2-5, and dorsal MPJ soft tissue release. Hopefully, this will remove retrograde forces and alleviate metatarsalgia/IPK symptoms. Does this approach sound reasonable? Any peri-operative tips or pearls? Is use of bisphosphonates helpful? Is pre-op C-spine x-ray (analogous to RA patients) recommended? Is use of K-wires okay? Is it okay for the patient to be WB with a walker boot post-op or should she be completely NWB, and for how long?