Case: Osteopetrosis is a genetic condition that impairs bone turnover as the result of defects in osteoclast function and abnormal ossification of bone. Autosomal dominant osteopetrosis is often mild; however, the impaired fracture healing, increased density, and hardness of osteopetrotic bone present technical challenges for surgeons leading to complications with both nonoperative and operative treatment modalities. In this case report, we describe a patient treated empirically with ultrasonic bone stimulation for nonunion of fractures of multiple metatarsals after a failure of conventional therapy. Conclusion: Ultrasonic bone stimulation may have a role in optimizing nonoperative management of osteopetrosis-related fractures in adults.

ä As a result of the advances in surgical technique and implant design, total hip arthroplasty (THA) is increasingly offered for the management of osteoarthritis of the hip in patients with fragile or pathologic bone.ä Posttraumatic or congenital deformities associated with fragile or pathologic bone are frequently encountered and necessitate diligent preoperative planning.ä Surgeons should be prepared to evaluate and manage intraoperative iatrogenic fracture.ä While there is limited evidence to date, components made with computer-assisted design can be considered, given the unique and highly variable patient population.Disclosure: The authors indicated that no external funding was received for any aspect of this work. On the Disclosure of Potential Conflicts of Interest forms, which are provided with the online version of the article, one or more of the authors checked "yes" to indicate that the author had a relevant financial relationship in the biomedical arena outside the submitted work (http://links.lww.com/JBJS/G443).