Successful open reduction and internal fixation for displaced femoral fracture in a patient with osteopetrosis

Huang, Jiangfa; Pan, Jianke; Xu, Mingtao; Xu, Shaofa

doi:10.1097/md.0000000000007777

Cited by 11 publications

(8 citation statements)

References 22 publications

(25 reference statements)

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“…External fixation is a temporary treatment that needs to be removed and fixed definitively later on, which decreases complication rates and infection risks as opposed to leaving the patient on external fixation [87]. The conversion of external to internal fixation depends on the patient's physical state and the condition of the local soft tissue.…”

Section: Treatments Of Open Femoral Diaphysis Fractures and Management In Polytraumatic Settingmentioning

confidence: 99%

Pediatric Femoral Shaft Fracture: An Age-Based Treatment Algorithm

Liau

Lin

Wang

et al. 2020

IJOO

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Purpose Fractures of the femoral shaft in children are common. The rates of bone growth and remodeling in children vary according to their ages, which affect their respective management. Methods This paper evaluates the incidence and patterns of pediatric femoral shaft fracture and the current concepts of treatments available. ResultsThe type of fracture-closed or open; stable or unstable-needs to be taken into account. Child abuse should be suspected in fractures sustained by infants. For younger children, non-surgical management is preferred, which include Pavlik harness (< 6 months old) and early spica casting (6 months to 6 years old). Older children (> 6 years old) usually benefit from surgical treatments as outcomes of non-surgical alternatives are worse and are associated with prolonged recovery times. These operative measures for older children that are 6-12 years old include elastic stable intramedullary nailing and submuscular plating. Factors to be considered when devising an appropriate intervention include body mass, location of injury, and nature of fracture. For adolescent and skeletally mature teenagers (> 12 years old), rigid antegrade entry intramedullary fixation is indicated. In the event of open fractures or polytrauma, external fixation should be considered as a temporary treatment method for initial fracture stabilization. Conclusion An age-based and evidence-based algorithm has been proposed to guide surgeons in the process of evaluating an appropriate treatment.

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Section: Treatments Of Open Femoral Diaphysis Fractures and Management In Polytraumatic Settingmentioning

confidence: 99%

Pediatric Femoral Shaft Fracture: An Age-Based Treatment Algorithm

Liau

Lin

Wang

et al. 2020

IJOO

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“…Osteopetrosis is a group of rare genetic diseases characterized by overly dense bones throughout the body[ 1 , 2 ]. Among the three types of osteopetrosis, autosomal recessive osteopetrosis (ARO) exhibits the most serious clinical symptoms, which generally manifest in infancy in the form of developmental malformations and abnormalities of multiple organs and systems, truly being a life-threatening disease[ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Treatment for subtrochanteric fracture and subsequent nonunion in an adult patient with osteopetrosis: A case report and review of the literature

Yang¹,

Shao²,

Du³

2021

WJCC

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BACKGROUND As a congenital metabolic bone disease caused by defective osteoclastic resorption of immature bone, osteopetrosis is characterized by diffused sclerosis of bones, brittle bones, easy fracturing, narrow medullary canals, and a weak fracture healing ability. At present, clear standards and principles for the treatment of fractures in patients with osteopetrosis are lacking. Non-operative treatment can prevent fracture hematoma and preserve the blood supply to the bone fragments, while being associated with frequent failures and higher mortality rates. Meanwhile, closed reduction and internal fixation with intramedullary nail (CRIF + IMN) approaches can also protect blood supply to the fracture site. However, IMN cannot be used for the vast majority of patients with osteopetrosis due to the narrowing of medullary canals. Thus, open reduction and internal fixation with plate remains the most appropriate surgical method for treating fractures in patients with osteopetrosis, but this approach is complicated by the lack of intramedullary hematopoiesis in such patients. Fracture healing primarily depends on the blood supply to the external periosteum. Open reduction can also easily destroy the periosteum and cause delayed fracture healing or even nonunion; however, CRIF may be the most practical approach. As a result, it would be prudent to solve the difficulty of drilling during the operation and the problem of postoperative nonunion. CASE SUMMARY In 2018, we treated an adult patient with osteopetrosis presenting with a subtrochanteric fracture. The fracture was fixed using a femoral locking compression plate. Because of delayed consolidation, at 12 mo postoperatively the patient was further treated with platelet-rich plasma (PRP) combined with radial extracorporeal shock wave therapy (rESWT). Antero-posterior and lateral radiographs obtained at the latest follow-up (10 mo) showed that the callus had grown at the original fracture site, and the medial fracture line almost disappeared. CONCLUSION Osteosynthesis remains the first choice of treatment approach for fractures in patients with osteopetrosis, especially peritrochanteric fractures. Preoperative preparation is necessary to avoid risks such as drill bit breakage and iatrogenic fracture during the operation. Moreover, fractures in a patient with osteopetrosis present with a high risk of delayed union and nonunion, which can be potentially cured with PRP + rESWT.

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“…Dysfunctional osteoclast activity is predominantly due to defective chloride channel 7 (ClCN7) and T cell immune regulator 1 (TCIRG1) (116 kD subunit of vacuolar proton pump) genes. 5 These result in impairment of acidification due to defective proton pumps leading to decreased acid secretion and subsequent bone reabsorption. In addition, defects to receptor activating NF-κ B ligand (RANKL) along with monocyte–macrophage-colony-stimulating factor (M-CSF) genes are responsible for inhibiting the maturation of functional, osteoclast formation.…”

Section: Introductionmentioning

confidence: 99%

“…Equipment breakages as well as blunting can occur intraoperatively leading to the use of specific instruments, such as diamond-tipped drills with regular changes, and special attention needs to be applied to the cooling of instruments to help prevent subsequent bone necrosis. 5 …”

Section: Introductionmentioning

confidence: 99%

Intramedullary Canal-creation Technique for Patients with Osteopetrosis

Kent

Ferguson

2020

Strategies in Trauma and Limb Reconstruction

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Aim We present details of a surgical technique to create an intramedullary canal to allow intramedullary fracture fixation in patients with osteopetrosis. Clinical cases are used to facilitate the description. Background Osteopetrosis is a rare, hereditary condition characterised by hard, brittle, “marble bone;” primarily due to osteoclast dysfunction. Patients are prone to fractures and subsequently nonunions, periprosthetic fractures, and metal-ware failure are commonly seen. Due to the increased bone density, deformity, and obliteration of the medullary cavity, fracture fixation is also technically demanding. Technique Creation of a medullary canal allows the use of intramedullary fixation rather than plate and screws for long-bone fractures. Key factors: A new sharp drill bit should be used for each case as blunt drills are more likely to break. Bone is drilled in a pulsatile fashion, with withdrawal every 2–4 seconds for bone swarf to be removed. Constant cooling of the drill bit with saline to help prevent bone necrosis and drill breakage. Regular exchanging of drill bit sizes to expand the canal. The smaller drills start the canal and are used to direct progress. Sequential expansion during canal creation is preferred. Regular use of orthogonal radiographs to ensure correct canal positioning and prevent perforation. Conclusion The creation of an intramedullary canal allows intramedullary fracture fixation. In our experience, this technique gives the orthopaedic surgeon a safe and effective method for treating long-bone fractures in patients with osteopetrosis. Clinical relevance Fractures and nonunions in patients with osteopetrosis are difficult to manage; and by detailing this technique, a further option is now available for surgeons when deciding upon fixation method. How to cite this article Kent J, Ferguson D. Intramedullary Canal-creation Technique for Patients with Osteopetrosis. Strategies Trauma Limb Reconstr 2019;14(3):155–162.

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Successful open reduction and internal fixation for displaced femoral fracture in a patient with osteopetrosis

Cited by 11 publications

References 22 publications

Pediatric Femoral Shaft Fracture: An Age-Based Treatment Algorithm

Pediatric Femoral Shaft Fracture: An Age-Based Treatment Algorithm

Treatment for subtrochanteric fracture and subsequent nonunion in an adult patient with osteopetrosis: A case report and review of the literature

Intramedullary Canal-creation Technique for Patients with Osteopetrosis

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