Mid-term outcomes of surgical treatment in fractures in patients with osteopetrosis.

AIMS Osteopetrosis (OP) is a rare hereditary disease that causes reduced bone resorption and increased bone density as a result of osteoclastic function defect. Our aim is to review the difficulties, mid-term follow-up results, and literature encountered during the treatment of OP. METHODS This is a retrospective and observational study containing data from nine patients with a mean age of 14.1 years (9 to 25; three female, six male) with OP who were treated in our hospital between April 2008 and October 2018 with 20 surgical procedures due to 17 different fractures. Patient data included age, sex, operating time, length of stay, genetic type of the disease, previous surgery, fractures, complications, and comorbidity. RESULTS The mean follow-up period was 92.5 months (25 to 140). Bony union was observed in all of our patients. Osteomyelitis developed in two patients with femoral shaft fractures, and two patients had peri-implant stress fractures. CONCLUSION Treatment of fractures in OP patients is difficult, healing is protracted, and the risk of postoperative infection is high. In children and young adults with OP who have open medullary canal and the epiphyses are not closed, fractures can be treated with surgical techniques such as intramedullary titanium elastic nail (TENS) technique or fixation with Kirschner (K)-wire. Cite this article: Bone Joint J 2020;102-B(8):1082-1087.

[1]  K. Takeshita,et al.  Open reduction and internal fixation using a locking compression plate as treatment for subtrochanteric fracture in two patients with osteopetrosis. , 2019, Injury.

[2]  R. Lakdawala,et al.  Inheritance patterns, challenges, and outcomes of fracture management in osteopetrosis patients. CASE series and review of pertinent literature , 2018, Annals of medicine and surgery.

[3]  E. Kwek,et al.  Fractures in patients with osteopetrosis, insights from a single institution , 2018, International Orthopaedics.

[4]  P. Guggenbuhl,et al.  High bone mass in adults. , 2018, Joint, bone, spine : revue du rhumatisme.

[5]  M. Econs,et al.  Osteopetroses, emphasizing potential approaches to treatment. , 2017, Bone.

[6]  N. Aydogan,et al.  Surgical Treatment of Osteopetrosis-Related Femoral Fractures: Two Case Reports and Literature Review , 2014, Case reports in orthopedics.

[7]  V. Jain,et al.  Metachronous bilateral subtrochanteric fracture of femur in an osteopetrotic bone: A case report with technical note. , 2012, Journal of clinical orthopaedics and trauma.

[8]  T. Brockamp,et al.  Osteopetrosis--a challenge for the orthopaedic surgeon. , 2009, South African journal of surgery. Suid-Afrikaanse tydskrif vir chirurgie.

[9]  A. Bhargava,et al.  "Challenges in the management of fractures in osteopetrosis"! Review of literature and technical tips learned from long-term management of seven patients. , 2009, Injury.

[10]  D. Burton,et al.  A new modality of treatment for non-united fracture of the humerus in a patient with osteopetrosis: a case report , 2009, Journal of medical case reports.

[11]  J. Auerbach,et al.  Posterior Cervical Arthrodesis for Subacute Odontoid Fracture in a Patient With Osteopetrosis: Case Report , 2007, Spine.

[12]  G. Bannister,et al.  Conversion of failed proximal femoral internal fixation to total hip arthroplasty in osteopetrotic bone. , 2006, The Journal of arthroplasty.

[13]  A. Kline,et al.  Management of proximal femoral shaft fractures in osteopetrosis: a case series using internal fixation. , 2005, Orthopedics.

[14]  Ravi Gupta.  Long bone fractures in osteopetrosis: awareness of primary pathology and appropriate pre-operative planning necessary to avoid pitfalls in fixation , 2005 .

[15]  C. von Eiff,et al.  Osteopetrosis, femoral fracture, and chronic osteomyelitis caused by Staphylococcus aureus small colony variants (SCV) treated by girdlestone resection – 6-year follow-up , 2002, Archives of Orthopaedic and Trauma Surgery.

[16]  N. Gupta,et al.  Femoral fractures in osteopetrosis: case reports. , 2001, The Journal of trauma.

[17]  D. Armstrong,et al.  Orthopedic management of osteopetrosis: results of a survey and review of the literature. , 1999, Journal of pediatric orthopedics.

[18]  F. Shapiro.  Osteopetrosis. Current clinical considerations. , 1993 .

[19]  J. Bollerslev,et al.  Autosomal dominant osteopetrosis. , 1993, Clinical orthopaedics and related research.

[20]  G. Bergmann,et al.  Hip joint loading during walking and running, measured in two patients. , 1993, Journal of biomechanics.

[21]  J. Bollerslev,et al.  Fracture patterns in two types of autosomal-dominant osteopetrosis. , 1989, Acta orthopaedica Scandinavica.

[22]  M. Jasty,et al.  Osteopetrosis. A morphological study of twenty-one cases. , 1982, The Journal of bone and joint surgery. American volume.

[23]  F. Vellios,et al.  OSTEOPETROSIS: A Clinical, Genetic, Metabolic, and Morphologic Study of the Dominantly Inherited, Benign Form , 1968, Medicine.