Diagnostic and Therapeutic Challenge in a Child With Osteogenesis Imperfecta-Case Report and Literature Review

Abstract

The treatment of fractures in children with osteogenesis imperfecta depends on several factors: the patient's age, the type and location of the fracture, the degree of fracture displacement and the type of osteogenesis imperfecta. Operative management varies and evidence is limited. We present a case report of operative treatment in an 8-year-old boy, admitted to our hospital within two years with displaced femoral shaft fractures. The past medical history was significant for multiple fractures managed conservatively. During the first hospitalization, after osteosynthesis of the right femoral shaft fracture, we extended the investigations for bone fragility. The history, clinical signs, low bone mineral density (BMD) level and genetic test, all led to the diagnosis of osteogenesis imperfecta type IV. After 1 year and 3 months from the first osteosynthesis with titanium elastic nails the patient returns to our emergency department with left displaced femoral shaft fracture. This time we stabilized the shaft fracture with the same type of osteosynthesis with elastic titanium nails. At two years after surgery, we found no inequalities of the lower limbs or joint stiffness.