Elastic intramedullary nailing of the femur fracture in patients affected by osteogenesis imperfecta type 3: Indications, limits and pitfalls

Persiani, P.J.; Martini, Lorena; Ranaldi, Filippo Maria; Zambrano, Anna; Celli, Mauro; Celli, Luca; D’Eufemia, P; Villani, Ciro

doi:10.1016/j.injury.2019.01.045

Cited by 17 publications

(8 citation statements)

References 25 publications

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“…The use of TEN may be considered as a less invasive approach compared to telescopic nail surgery, however only temporarily, as it will still most probably require a surgical revision a few years down the line, in moderate or severe osteogenesis imperfecta types [20].…”

Section: Discussionmentioning

confidence: 99%

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

2021

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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.

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Section: Discussionmentioning

confidence: 99%

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

2021

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“…However, IMN with or without an osteotomy is sometimes the only reliable option in cases of heritable bone disease such as osteogenesis imperfecta and X-linked hypophosphatemic rickets. [ 9 , 10 ] In AD II osteopetrosis, the long bones are usually straight but have only traceable amounts of medullary canal. Despite the narrow medullary canal, closed IMN was possible owing to the sequential use of instruments that could keep the reamers at the center of the partially obliterated medullary canal.…”

Section: Discussionmentioning

confidence: 99%

Intramedullary nailing for subtrochanteric fracture in autosomal dominant Type II osteopetrosis

et al. 2020

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Rationale: Autosomal dominant type II (AD II) osteopetrosis is a rare inheritable metabolic bone disease characterized by hard but brittle bone and a narrow medullary canal. Intramedullary nailing (IMN) is a difficult but attractive option for the treatment of subtrochanteric fractures in patients with AD II osteopetrosis. Patient concerns and diagnosis: Two patients with AD II osteopetrosis sustained subtrochanteric fractures after a fall. Interventions: IMN was performed through the sequential use of instruments such as a 4.9-mm drill bit, small reamer, and larger reamer for over-reaming. Outcomes: In the first case, IMN left some gap at the fracture site. Dynamization was performed to treat the delayed union at 6 months postoperatively. The fracture healed at 10 months after the dynamization. In the second case, IMN was successful without a gap, and the fracture healed at 8 months. Lessons: Although IMN is difficult to perform owing to partial obliteration of the medullary canal in AD II osteopetrosis, it can be performed with sequential widening of the medullary canal using various instruments. In addition, the fracture gap should not be left uncorrected during IMN to attain fracture union.

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“…Due to the structure of the bone and the deformity of the femur, conventional osteosynthesis for adults would be too rigid and lead to new fractures or implant failures (Figure 1). Persiani et al reported results with ESIN in children with type III OI and came to the conclusion that ESINs are the most suitable type of osteosynthesis for femoral shaft fractures with OI [12].…”

Section: Discussionmentioning

confidence: 99%

Osteosynthesis of a Multifragment Femoral Shaft Fracture and Peri-Implant Refracture in an 83-Year-Old Patient with Osteogenesis Imperfecta

Ballhause

Gessler

Priemel

et al. 2020

Case Reports in Orthopedics

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Introduction. Osteogenesis imperfecta (OI) is the term for a heterogenic group of conatal diseases that affect the bone formation. Eight different OI types are known. Patients with types III and IV frequently suffer from fractures without adequate trauma. The literature gives plenty advice for fracture treatment in pediatric OI patients, but there is less for adults, and no recommendations can be found for geriatric OI patients. Case Presentation. We report on an 83-year-old male who suffered from OI type IV. He was able to walk with an individually adapted gait orthosis. In an accident, the patient sustained a distal, multifragment, femoral shaft fracture. The fracture was openly reduced and fixated with a retrograde inserted elastic stable intramedullary nail (ESIN). Three months later, the patient was capable of walking without crutches. Due to another accident, he sustained a peri-implant refracture without failure of the ESIN. We immobilized the leg, and it achieved bony healing without reosteosynthesis. Eleven weeks later, he was again able to mobilize himself with full weight bearing. Discussion. We present a unique case of osteosynthesis in a distal, multifragment, femoral shaft fracture in a geriatric OI patient. No recommendations for the treatment of mature patients with OI can be found in the literature. We present our treatment concept and technique of osteosynthesis with an ESIN. Despite another accident with a peri-implant refracture, sufficient bony healing occurred, which allowed the patient to freely mobilize himself again.

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Elastic intramedullary nailing of the femur fracture in patients affected by osteogenesis imperfecta type 3: Indications, limits and pitfalls

Cited by 17 publications

References 25 publications

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

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

Intramedullary nailing for subtrochanteric fracture in autosomal dominant Type II osteopetrosis

Osteosynthesis of a Multifragment Femoral Shaft Fracture and Peri-Implant Refracture in an 83-Year-Old Patient with Osteogenesis Imperfecta

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