Subtrochanteric femoral fractures in osteopetrotic patients: problematic cases to handle

Abstract

Background: Osteopetrosis is characterized by abnormally diminished osteoclast mediated skeletal resorption that leads to excessive accumulation of bone matrix, causing hard, dense bones with obliteration of the medullary canal, but with fragile, brittle bone. Osteopetrosis is endemic in North Sinai. The aim of the study was to assess the results of treatment of osteopetrotic subtrochanteric femoral fracture by open reduction and internal fixation using a locked plate combined with intramedullary reaming, describing the difficulties and the technical tips during fixation. Methods: Eight patients with osteopetrotic subtrochanteric femoral fractures (bilateral in two patients but not simultaneous) were treated. Osteosynthesis with internal fixation was performed using proximal femoral locked plates (in eight femora) or a dynamic hip screw (in two femora). Proper preoperative planning, presence of spare drill bits, patience during opening the medullary canal, and extra care with the sterilization rules are necessary. Delayed or nonunion and infection should be included in the informed consent. Results: No perioperative complications including infection, implant failure, or nonunion were observed during the follow-up period. All fractures healed at an average of 6.4 mo (6-8.4 mo) with no patients requiring bone grafting or additional procedures. All the patients were able to walk without pain and without assistance at the final follow-up. Conclusions: Management of osteopetrotic subtrochanteric femoral fractures by open reduction and internal fixation using locked plates combined with medullary canal reaming with extra care of the perioperative and intraoperative challenges and complications achieve successful results.