Augmentation of simultaneous acetabular and femoral neck fracture in osteogenesis imperfecta using photodynamic bone stabilization — A case report

Abstract

Background: Surgical fracture treatment in patients suffering from “osteogenesis imperfecta” (OI) is challenging and often results in unsatisfactory fixation of implants due to altered bone quality. Even the use of locking plates bears a residual risk to develop a loss of reduction leading to secondary fracture dislocation. However, the augmentation with an intramedullary photodynamic bone stabilization system (PBS) (e.g. Illuminoss®) may increase bone stability and allow for a sufficient anchorage of established implants even in OI patients. Case presentation: We report the case of a 41-year-old male patient with the diagnosis of OI. He sustained a medial femoral neck fracture (Garden type IV, Pauwels type III) and a fracture of the acetabulum (AO-Type 62-B.3) – both right-sided – after a blunt trauma during a bicycle accident. The medial femoral neck fracture was subsequently surgically treated to preserve the femoral head. After augmentation of the proximal femur with the PBS, a Dynamic Hip Screw (DHS) was implanted. After a short recovery, the acetabular fracture was surgically treated by intramedullary augmentation and locking plate fixation.The patient was discharged seven days after the surgical intervention of the acetabular fracture. Partial weight-bearing activities of the right lower extremity were performed on crutches for 6 weeks. The patient was able to do his outpatient rehabilitation program without any complications. He returned to work eight weeks after surgery. After a follow-up of four months, the patient presented full weight-bearing without assistance. No physical complaints were reported 14 months after surgery (Harris Hip Score 90). Conclusion: To the best of our knowledge, we report the augmentation with a photodynamic bone stabilization system of internal fixation techniques in an OI patient with fractures of the femoral neck and the acetabulum for the first time. This advanced surgical procedure shows the high potential of intramedullary photodynamic bone stabilization in patients with minor bone quality. Keywords: Osteogenesis imperfecta, Fracture treatment, Bone augmentation, Photodynamic bone stabilization system, Illuminoss®