Advantages and disadvantages of the combination of plate and nail in surgical treatment of patients diagnosed with osteogenesis imperfecta compared to solely nail application

Introduction: Osteogenesis Imperfecta (OI) is an inherited connective tissue disorder characterized by multiple fractures and skeletal deformities caused by mutations in genes encoding Type 1 collagen. In our study, patients with fractures and deformities due to OI were compared between those treated with additional support using plates after shaft osteotomy and intramedullary (IM) nail and those treated only with IM nail. Methods: In a single-center retrospective study, the relationship between radiological and functional scores and the surgical fixation method was investigated in patients diagnosed with OI who underwent surgery using solely intramedullary nails or intramedullary nails with plate support for at least 12 months. Patient and segment-based analyses were conducted, comparing the functional status and mechanical complications among groups. Data: The study included 24 patients with a mean age of 21.13 ± 11.92, with an initial surgical age of 13.71 ± 9.36. Fifteen patients (62.50%) were from the pediatric population.There were 10 female patients (41.67%) and 14 male patients (58.33%). The average follow- up duration was 102.79 ± 72.85 months. The mean number of segments operated on in patients was 2.38 ± 1.10, with a total surgical count of 2.79 ± 1.50. According to Sillence classification, 9 patients (37.50%) were in class 1, 10 patients (47.67%) in class 3, and 5 patients (20.83%) in class 4. Six patients (25.00%) had a family history of OI or connective tissue disease. Other findings in OI included scoliosis in 17 patients (70.83%), dentinogenesis imperfecta in 9 patients (39.13%), hearing impairment in 2 patients (8.70%), short stature in 16 patients (69.57%), and contractures in 8 patients (33.33%). The mean Beighton score was 0.26 ± 0.69. The most common symptom in the study group during periods without acute fractures was fatigue (60.87%). A total of 24 patients underwent surgery for 64 segments, with nails used in 32 segments (50%) and nails + plates in 32 segments (50%). The mean consolidation time was 13.31 ± 4.20 weeks, significantly longer in the nail group (15.56 ± 2.99 weeks) compared to the nail + plate group (11.06 ± 4.06 weeks) (p=0.0000). Post-surgical complications were observed in 27 segments, with 15 in the nail group and 12 in the nail + plate group. Statistically significant differences between groups were only observed for periprosthetic fractures, with all 47 cases occurring in the nail group (p=0.005). A total of 9 segments required revision, all in the nail group. Conclusion: Planning is crucial before orthopedic interventions aimed at correcting or preventing fractures and deformities. The use of nails + plates results in a shorter consolidation time and a lower risk of implant-related fractures.