Individualized Implant: A surgical advice for rotational stability and additional proximal locking of the Fassier-Duval telescoping nail

Background: When stabilizing fractures and osteotomies in growing patients with special conditions of the long bones, the use of the Fassier-Duval nail as intended by the manufacturer (Pega Medical, Quebec, Canada) [1], shows that one problem with passive telescopic nails has not yet been solved. No stability in the rotation can be achieved. Postoperative to immobilize with plaster casts are obsolete in patients with osteogenesis imperfecta, as additional osteopenia due to immobilization must be feared. Especially with fractures and osteotomies in proximal femur long leg spica casts are a torture to patients and caregivers. Methods: By experience in different surgical procedures in usage of the Fassier-Duval nailing system a technical solution for rotational stability of the nail as well as for locking of the nail in the proximal and distal physis could be developed. Results: A transverse slot can be cutted in all available diameters of the female parts to make the FD nail rotationally stable. A proximal locking hole can be drilled individually by the surgeon on the operating table. The technical solution to the problems is presented in two exemplary cases in this article. Conclusions: Rotational stability and additional proximal locking options can be achieved by additionally individualization of the Fassier-Duval telescoping nail during surgery.