Lower limb deformity correction in osteogenesis imperfecta: Experience with double intramedullary nailing and locally-made devices in Vietnam

Background: Osteogenesis imperfecta (OI) is a rare genetic disorder that results in fragile bones and frequent fractures, often causing lower limb deformities. Surgical correction is challenging due to poor bone quality. This study examines the outcomes of lower limb deformity correction in Vietnamese patients with OI using double intramedullary nailing and locally made devices. Methods: A prospective descriptive study was conducted on 33 patients with OI who underwent corrective osteotomy and internal fixation of the lower limb at Military Hospital 7A. The primary technique involved double intramedullary nailing using Kirschner or Rush pins and locally-made instruments for widening the medullary canal when necessary. Outcomes measured included operative time, complications, radiographic axis correction, and functional recovery. Follow-up was performed at 6, 12, 24, and 36 months. Results: 33 patients underwent surgical procedures, which amounted to 47 operations on 53 bone segments. Axis correction was achieved in all cases (100 %), and early bone union at 6 months was observed in 95.56 % of available segments. According to the El Sobky score, 96.43 % of patients achieved excellent results at 6 months; rates of good or excellent outcomes remained above 90 % at 1, 2, and 3 years postoperatively. However, only 50 % of patients achieved independent ambulation at 1 year. Two cases (7.14 %) of non-union required reoperation. Notably, follow-up attrition was considerable, with only 17 of 33 patients available at the 36-month evaluation. Conclusion: Double intramedullary nailing with locally-made devices can achieve satisfactory axis correction and radiological outcomes for lower limb deformities in OI patients in resource-limited settings. However, functional recovery remains limited, and the absence of a control group, small and heterogeneous sample, and significant loss to follow-up restricts the generalizability of these findings. Further comparative studies with standardized rehabilitation protocols and longer-term assessments are warranted.