Femoral neck fractures in osteogenesis imperfecta treated with bisphosphonates

Abstract

PurposeOsteogenesis imperfecta (OI) is a condition characterised by bone fragility and multiple fractures, which cause considerable morbidity in the affected patients. Most cases are associated with mutations in one of the type I collagen genes. Recently, bisphosponates have been used widely to reduce pain and the incidence of fragility fractures in OI in children, even though there have been concerns raised regarding the long-term complications of it due to their effect on the bone. The fragility fractures involving the neck of the femur in children with intramedullary rods in the femoral shaft are very difficult to treat. Although these fractures are frequently un-displaced, they require optimal internal fixation to achieve fracture union. The aim of this study was to assess the clinical and radiological outcomes of OI patients with intracapsular femoral neck fracture treated with headless compression screws.Method and resultsAt our institute, we identified seven patients (11 hips) with OI who underwent internal fixation with headless compression screws for a neck of femur fracture between June 2010 and Dec 2012. The time to fractures healing was on average 14 weeks (12 to 16). All patients gained their pre-injury ambulatory status.ConclusionIt is very challenging and technically demanding for orthopaedic surgeons when treating the fragility fracture of the neck of femur in patients with intramedullary rod in the femoral shaft. The published data regarding the management of these complex conditions are very limited. We describe our experience with the technique of percutaneous headless compression screw fixation for treating the femoral neck fractures in OI patients.

The relationship between femoral neck fracture in adult and avascular necrosis and nonunion: A retrospective study

“…Similar to most studies, the most common cause of FNFs in our studied population was secondary to a fall injury, which was documented in 37 patients (53.6%), followed by RTA in 16 patients (23.2%, Table 2 ). This finding is likely because most of our patients who had a fall injury were middle-aged males (mean age of 42.8 ± 19.1 years) with some co-morbid conditions such as DM and HTN, and RTA was found among younger adult males (mean age of 31.8 ± 5.2 years) without any co-morbid conditions [ [1] , [2] , [3] , [4] ]. Understandably, older men who have co-morbid conditions have a higher risk of fall injuries compared to females in this study since most of the comorbid conditions, such as DM and HTN, were seen among our male patients.…”

“…Femoral neck fractures (FNFs) are fractures of the flattened pyramidal bone connecting the femoral head and the femoral shaft. It is not common in healthy individuals but common among athletes, military recruits, and young adults because of high energy activities such as sports and road traffic accidents, in adults because of falls, in women because of estrogen imbalances, and in patients because of bone mineralization and deficiencies [ [1] , [2] , [3] , [4] ]. In the USA in 2013, there were a reported 146 cases per 100,000 people [ 5 ].…”

Atypical Femur Fracture Nonunion in a Patient with Osteogenesis Imperfecta

“…The femoral neck fracture was managed with operative stabilization using cannulated screws around the preexisting IM rod. The difficulty in treating femoral neck fractures around preexisting IM rod in patients with OI has been reported previously in few reports [4,5,18]. The ipsilateral incomplete AFF was initially managed conservatively due to fracture location around the IM implant.…”

“…Adolescents with OI are commonly treated with bisphosphonates to increase bone mineral density, reduce the incidence of fracture, and reduce bone pain [1][2][3]. Treatment of femoral neck fractures in patients with OI treated with cannulated screw fixation around a preexisting intramedullary (IM) rod poses a unique challenge in management, with few reports publishing successful outcomes [4][5][6] Nonetheless, there are increasing concerns regarding longterm effects of bisphosphonate treatment in adults for osteoporosis, and cases of atypical subtrochanteric femur fractures with long-term bisphosphonate use have been well described in the literature [7][8][9]. Nicolaou et al, described the pattern of complete subtrochanteric femur fractures that occur with bisphosphonate use in patients with OI, including 38% occurring in rodded femora [10].…”

Pauwels Osteotomy for Femoral Neck Nonunion in Two Adult Siblings with Osteogenesis Imperfecta

“…Chow's own series of 5 patients added to a total of 20 reported femoral neck fractures in OI. Papanna et al 8) reported on 7 pediatric patients (11 hips) with OI treated with a cannulated headless screw. All of them had been on bisphosphonates.…”