J Bone Metab.  2019 Aug;26(3):201-206. 10.11005/jbm.2019.26.3.201.

Lessons Learned from Long-Term Management of Hip Fracture in Patients with Osteopetrosis: A Report of Nine Hips in Five Patients

• Lim JY
• Kim BS
• Yoon BH
• Chang JS
• Park CH
• Koo KH

• KMID: 2457439
• DOI: http://doi.org/10.11005/jbm.2019.26.3.201

Abstract

BACKGROUND
Treating patients with osteopetrosis is very challenging even in very skilled surgeons with many experiences. We present an account of 5 patients treated for hip fracture related problems occurring throughout their life due to this disease. Difficulties encountered during their treatment prompted us to present some general management principles.
METHODS
From January 2003 to December 2016, 5 patients with osteopetrosis (9 hips; 3 men, 2 women), who underwent operative or conservative treatment were retrospectively reviewed. We evaluated their clinical features and rate of union, malunion and post-operative infection.
RESULTS
Four of 5 patients (80%) suffered bilateral fracture, and 8 of 9 fractures (89%) are transverse and occurred at subtrochanteric area resulted from minor trauma. Among 9 hips, surgery was performed in seven hips. Nonunion were found in 3 hips (33%), malunion in 1 hip (11%) and oteomyelitis was developed in 2 hips (22%) at a median of 8.1 years.
CONCLUSIONS
Clinical features of hip fracture in osteopetrosis are very similar to atypical subtrochanteric femoral fractures. Patients should be informed of the possibilities of several anticipated complications including the risk of nonunion and infection after surgery.

Keyword

Fracture fixation, internal; Hip fractures; Osteopetrosis

MeSH Terms

Femoral Fractures
Fracture Fixation, Internal
Hip Fractures
Hip*
Humans
Male
Osteopetrosis*
Retrospective Studies
Surgeons

Figure

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  Fig. 1 (A) An anteroposterior view of the pelvis obtained at the time of injury shows a right transverse subtrochanteric fracture and osteosclerotic appearance of the osteopetrotic bone. The patient suffered a postoperative infection after surgery of left femoral neck fracture. (B) Radiographs at 4 years after injury shows a healed right subtrochanteric fracture with coxa vara. The chronic osteomyelitis of left hip finally treated with Girdlestone operation.

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  Fig. 2 (A) An anteroposterior view of the pelvis obtained at the time of injury shows a transverse subtrochanteric fracture in left hip. He had been treated with subtrochanteric fracture at the right hip (contralateral limb) 8 years ago. (B) Postoperative anteroposterior radiographs obtained 1.2 years after surgery shows refracture occurred at the tip of plate. (C) Refixation using long dynamic hip screw plate was performed and the radiograph showed complete union of the fractures at 12 months postoperatively.

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