Implant strategies for femur fractures in osteopetrosis: Insights from a case series and literature review

Abstract

Background: A rare category of hereditary illnesses known as osteopetrosis (OP) causes increased bone radiodensity on radiographs. Due to brittle bone and frequent fractures, symptomatic management is the mainstay of treatment. The underlying pathology of osteopetrosis in a patient presenting with long bone fractures may be missed due to the rarity of the condition and lack of awareness on the part of the treating surgeon. There is no consensus on fracture management in osteopetrosis. When opting for surgical fixation of fractures, there is often a conflict about what implants to use to ensure stable fixation and early functional redemption. Iatrogenic fractures during implant placement, overheating, and drill/saw breakage are some of the difficulties that may arise during surgery. Methods: Our study is a retrospective observational analysis of eight patients with osteopetrosis who underwent surgery for a femur fracture with various types of implants at our facility between January 2010 and March 2022. Following surgery, clinico-radiological follow-ups were done at one, two, six months, 12 months, and then yearly thereafter. Clinically, the patients were assessed based on the Lower Extremity Functional Score (LEFS). Results: The patients who underwent combined extra and intramedullary fixation showed a faster return of LEFS and union time of the fracture. Conclusion: When addressing the fractures in osteopetrosis, it is crucial to consider the risks of fixation in these individuals. Although plate fixation is considered easier, the risk of peri-implant fractures is high. In our experience, intramedullary nailing with plate augmentation and bone grafting provides a much more stable construct which can reduce the risk of further fractures.

Keywords

• Osteopetrosis
• Femur fracture
• Subtrochanteric fracture
• Intramedullary nailing
• Nail plate construct