Bilateral fractures of acetabulum in a young girl with osteogenesis imperfecta and epilepsy

Abstract

We report a case of bilateral displaced acetabular fractures including both columns fractures with protrusio acetabuli in a female patient, aged 15 years, with osteogenesis imperfecta (OI) (Sillence Type I), epilepsy, blue sclera and bilateral ipoacusia. Since OI is a rare genetic disorder characterized by an increased propensity to osteopenia, intraoperative fracture risks and hemorrhagic diathesis, we opted for the open reduction and internal fixation of the acetabula in two surgical steps and using two different approaches. Although the clinical outcomes are not excellent in this report (HHS 45/100), the authors suggest that chances of a good outcome with reconstruction of the acetabulum must be balanced against the benefits of early or late total hip arthroplasty. The goal was to delay a joint replacement as long as possible due to the patient's young age.Level of evidence: V, case report.

Management and Outcomes of Bilateral Acetabular Fractures: A Critical Review of the Literature

“…Follow-up was reported in 72% (34/47) of the cases with a range of 1.5–56 months, (mean 19.8 months) [ 5 – 16 , 18 – 28 , 30 , 32 – 41 ]. The most common MOI was high energy in 49% (23/47; male/female ratio (M/F) = 3.6/1) [ 8 , 12 , 13 , 15 , 20 , 25 , 26 , 29 , 30 , 33 , 34 , 36 , 38 , 39 ], followed by seizures in 45% (21/47; M/F = 3.2/1) [ 6 , 9 – 11 , 14 , 16 , 17 , 19 , 21 – 24 , 27 , 31 , 32 , 35 , 37 , 40 , 41 ], and lastly by insufficiency fractures secondary to osteoporosis 6% (3/47) (Table 2 ) [ 5 , 7 , 28 ]. High-energy injuries were secondary to RTAs (70%; 16 patients) [ 12 , 13 , 15 , 20 , 26 , 29 , 30 , 33 , 34 ], falls from height (13%; 3 patients) [ 8 , 38 , 39 ], direct blows (9%; 2 patients) [ 25 , 30 ], crush injury (4%; 1 patient) [ 34 ], and unknown mechanism (4%; 1 patient) [ 18 ].…”

“…High-energy injuries were secondary to RTAs (70%; 16 patients) [ 12 , 13 , 15 , 20 , 26 , 29 , 30 , 33 , 34 ], falls from height (13%; 3 patients) [ 8 , 38 , 39 ], direct blows (9%; 2 patients) [ 25 , 30 ], crush injury (4%; 1 patient) [ 34 ], and unknown mechanism (4%; 1 patient) [ 18 ]. Mean age was 38 years (range 15–82) for the high-energy group [ 8 , 12 , 13 , 15 , 18 , 20 , 25 , 26 , 29 , 30 , 33 , 34 , 36 , 38 , 39 ], 55 years (range 13–84) for the seizure group [ 6 , 9 – 11 , 14 , 16 , 17 , 19 , 21 – 24 , 27 , 31 , 32 , 35 , 37 , 40 , 41 ] and 47 years (range 23–70) for the insufficiency fractures group [ 5 , 7 , 28 ].…”

“…The Letournel and Judet classification [ 44 ] was reported in 77% (36/47) of cases [ 6 , 7 , 10 , 12 – 15 , 17 , 18 , 20 , 21 , 25 – 27 , 29 – 41 ], whereas the remaining fractures were not classified [ 5 , 8 , 11 , 16 , 19 , 22 , 24 – 28 ]. Overall, the most frequent type was associated both column fracture (ABC) with 18%, followed by anterior column (AC) with 17%, while the least common was posterior wall and column (PWC) with 4% and T-shaped ( T ) with 3%.…”

“…Overall, there were 58% excellent/good outcomes with complete functional recovery and independent mobilization [5, 7, 9, 10, 13, 15-18, 22, 25, 26, 28, 31, 33-35, 38-40], 22% fair with limited range of motion of both hips and moderate pain [6,8,23,30,32,34,36,37], and 20% poor outcomes with limited activity and walking ability (Table 7) [11,12,14,20,21,24,34]. According to injury group, excellent/good outcomes were reported in 60% of the high-energy patients [13,15,18,25,26,33,34,38,39], 47% of the seizures patients [9,10,16,17,22,31,35,40], and in 100% of the insufficiency fracture group [5,7,28].…”

“…Heterotopic ossification [6,21,33,37] 11% (4) Nerve injury [12,20,33,36] 11% (4) Degenerative arthritis [6,30] 6% (2) DVT [14,36] 6% (2) Infection [8] 3% (2) Abductor muscle weakness [24] 3% (1) the low energy mechanism acetabular fractures were treated initially conservatively and subsequently received late THA [54]. In unilateral acetabular fractures in the elderly, especially when femoral head fractures are present, early stage THA has shown good clinical results when combined with stable fracture fixation [58,59].…”