Management pitfalls of fractured neck of femur in osteogenesis imperfecta

Abstract

Introduction Fractured neck of femur in osteogenesis imperfecta is rarely reported. Its management is always difficult because of bone fragility and the outcome is not well known. We, therefore, aimed to study the management pitfalls in this group of patients. Methods We retrospectively reviewed five cases of fractured neck of femur in four patients treated in our hospital between 2006 and 2009. The demographic data, mode of injury, fracture configuration, treatment, complications, clinical and radiological outcome were reviewed. Results According to the Sillence classification, one patient was type I, two were type III and one was type IV. There were two children (aged 8 and 15 years) and two adults (aged 21 and 22 years), with the 8 year-old girl suffering from hip fracture on different sides in two accidents. All five hip fractures were the result of low-energy injury and were associated with other fractures. Two undisplaced fractures required intra-operative fluoroscopic confirmation to demonstrate movement at the fracture site.

Incidence and treatment of femur fractures in adults with osteogenesis imperfecta: an analysis of an expert clinic of 216 patients

“…Although femur fractures are common in OI patients, no literature specifies fracture and non-union incidence in adults, most likely explained by the rarity of this disease [6][7][8]. Non-union rate is expected to be higher in OI adults than non-OI adults, as surgical treatment is more challenging due to anatomical and bone-related abnormalities [7,9,10].…”

Challenges of Fracture Management for Adults With Osteogenesis Imperfecta

“…23 However, fractures of the femoral neck are relatively uncommon in patients with osteogenesis imperfecta. 19,23,24 Surgical stabilization of femoral neck fractures is challenging because of low bone mineral density or obstruction by hardware from previous…”

“…fracture fixation, specifically the presence of femoral intramedullary hardware that was used for stabilization of the femoral shaft in pediatric patients with osteogenesis imperfecta. 19 Chow et al 24 reported the management of femoral neck fractures in 2 adults with osteogenesis imperfecta. The first case involved a 22-year-old woman who sustained a femoral neck fracture and a supracondylar fracture of the distal femur.…”

“…The fracture had healed at 3 months without deformity. 24 Because of their poor quality bone, limited size and therefore rigidity of osteosynthesis implants, and often limited ability to adequately stabilize fractures with internal fixation alone, it is important to augment any internal fixation with supplemental spica cast immobilization when treating femur fractures in adults with osteogenesis imperfecta. Although normal size adults may be poorly tolerant of spica cast immobilization, patients with osteogenesis imperfecta are much smaller and the spica cast burden is often better tolerated.…”

Femoral neck fractures in osteogenesis imperfecta patients: A retrospective case series and novel surgical technique

“…There are additional factors that complicate surgical management in this patient population including poor bone quality, difficult radiographic visualization of the proximal femur secondary to deformity and severe osteoporosis, small patient size, and the frequency of preexisting implants. [6] Within our institution, we report three cases of femoral neck fractures that occurred in patients with OI, and describe a technique of improving fluoroscopic visualization of proxi-mal femoral anatomy in patients with severe osteopenia.…”