Incidence and treatment of adult femoral fractures with osteogenesis imperfecta: An analysis of a center of 72 patients in Taiwan

Abstract

Background: Osteogenesis imperfecta (OI) is a rare disease characterized by increased bone fragility and susceptibility for fractures. Only few studies have compared the management for femoral fractures in children with OI. Nevertheless, no cohort studies have described the treatment for femoral fractures in adults with OI in Taiwan. This study aimed to investigate and compare the incidence of union and non-union femoral fractures and the best treatment options to avoid non-union fractures. Methods: We enrolled 72 patients with OI who were older than 18 years at MacKay Memorial Hospital between January 2010 and December 2018. Femoral fracture incidence, non-union rate, and treatment modality were analyzed. Results: Of 72 patients with OI, 11 patients had femoral fractures and 4 patients of them had >1 femoral fracture. The incidence for all types of femoral fractures was 651 fractures per 100,000 person-years annually. In 15 total fractures, 4 fractures resulted in non-union, and patients with type 4 OI mostly had shaft fractures. The best outcomes for non-union shaft fracture is achieved by surgical treatment. Conclusion: Adults with OI tended to develop femoral fractures and non-unions. Adults with type 4 OI were particularly at high risk for non-unions in shaft fractures with conservative treatment.

Long Bone Fractures in Fibrous Dysplasia/McCune-Albright Syndrome: Prevalence, Natural History, and Risk Factors

“…( 17 ) This OI study did not investigate clinical associations with fractures; however, smaller studies support extensive variabilities in fracture rates among OI subtypes. ( 26,27 ) Similarly, in our study fracture rates were highly variable depending on FD skeletal disease burden, increasing threefold to 0.15 fractures/patient/year in the subgroup of patients with skeletal burden scores ≥25. Taken together, this data suggests that long‐bone fractures are an important source of morbidity in the overall population of patients with FD/MAS; however, fractures vary extensively between patients, determined in part by differences in FD skeletal disease burden.…”

Comparison of Iliac Bone Transplantation with Bone Transport in the Treatment of Femur Fracture and Bone Defect

“…However, in daily clinical practice, the exact choice of the implant is still unclear to the individual surgeon, necessitating the use of an easy-to-use, evidence-based surgical approach that covers all types of femur fractures. Many articles recommend treatment of some aspect of surgery, but only a few authors have published a more or less explicit decision tree algorithm for surgical management of proximal femur fractures [ 5 , 7 , 8 ]. In some Western European countries, national guidelines for many aspects of hip fracture management have evolved over the past decade, including recommendations for surgical options for implants.…”

“…Many articles recommend treatment of some aspect of surgery, but only a few authors have published a more or less explicit decision tree algorithm for surgical management of proximal femur fractures [5,7,8]. In some Western European countries, national guidelines for many aspects of hip fracture management have evolved over the past decade, including recommendations for surgical options for implants.…”