Traumatic multiple cervical spine injuries in a patient with osteopetrosis and its management

Rathod, Ashok; Dhake, Rakesh Padmakar; Borde, Mandar Deepak

doi:10.1007/s00586-017-5083-x

Cited by 4 publications

(3 citation statements)

References 7 publications

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“…The majority of OPF were fractures around trochanteric region, such as femoral neck fractures, trochanteric and subtrochanteric fractures 15 , which may be on the account of concentrated stress. OPF in other bones such as tibia [30][31][32] , fibula 30,31 , humerus 16,33 , vertebrae 34,35 were also reported but relatively infrequent. In present study, case 1 had left humeral fracture about 30 years ago and recovered well with plaster immobilization.…”

Section: Discussionmentioning

confidence: 99%

The Treatment of Subtrochanteric Fracture with Reversed Contralateral Distal Femoral Locking Compression Plate (DF‐LCP) Using a Progressive and Intermittent Drilling Procedure in Three Osteopetrosis Patients

Liu

Jia

et al. 2021

Orthopaedic Surgery

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Objective To describe the application of reversed contralateral distal femoral locking compression plate (DF‐LCP) inserted through a progressive and intermittent drilling procedure in the treatment of osteopetrotic subtrochanteric fracture (OSF). Methods Three patients (one male and two females with an average age of 45.33 ± 11.09 years) with OSF hospitalized between September 2015 and September 2020, were included in this present study. Lateral approach was applied in all patients who accepted open reduction and internal fixation (ORIF) with a reversed contralateral DF‐LCP inserted through a progressive and intermittent drilling procedure. The operation time and intraoperative blood loss were recorded to evaluate the efficiency of this surgical method. Physical examination and imaging examination of the fracture site were used to evaluate the fracture union status, the position and stability of the implant, and the alignment of the injured limb at 1, 3, 6, and 12 months after operation, then a subsequent visit was conducted at least once a year. Harris Hip Score (HHS) was used to evaluate the hip joint function at 6 and 12 months after operation. Results The average operation time was 140 ± 21.60 min (110, 160, and 150 min); The average intraoperative blood loss was about 333.33 ± 23.57 ml (300, 350, and 350 ml). The average follow‐up time was 22.33 ± 7.41 months (29, 26, and 12 months). All patients achieved bone union with an average time of 6.67 ± 0.94 months (6, 8, and 6 months). At the time of 6 months after operation, case 1 and 3 were almost pain‐free and could walk with full weight bearing while case 2 could walk only with partial weight bearing using a crutch. The HHS scores of cases 1, 2, and 3 were 84/100, 74/100, and 92/100, respectively. At the follow‐up at 12 months after operation, the HHS score improved to 91/100, 81/100, and 96/100, respectively. The contralateral incomplete old subtrochanteric fracture was deteriorated in case 1 at 26 months after operation. After 3 months of limited weight bearing using a crutch, bone union was verified in radiograph imaging. Fresh contralateral subtrochanteric fracture occurred in case 2 at 26 months after operation, which was treated using a similar surgical approach, and its clinical outcome is under follow‐up. Moreover, no perioperative complications including operation‐related death, vascular/nerve injury, deep venous thrombosis, pulmonary embolism, and incision infection, and long‐term complications involving malunion, nonunion, implant failure, ankylosis, heterotopic ossification, osteonecrosis, and osteomyelitis were identified. Conclusion The application of reversed contralateral DF‐LCP in OSF is practicable and reliable. Progressive and intermittent drilling is a safe and efficient method for implant insertion in this complicated situation.

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Section: Discussionmentioning

confidence: 99%

The Treatment of Subtrochanteric Fracture with Reversed Contralateral Distal Femoral Locking Compression Plate (DF‐LCP) Using a Progressive and Intermittent Drilling Procedure in Three Osteopetrosis Patients

Liu

Jia

et al. 2021

Orthopaedic Surgery

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“…The fractures in the patients with osteopetrosis are usually caused following trivial trauma such as a fall within home or following minor accidents which is not expected to cause fractures in otherwise healthy individuals. There are many authors including Gandhi GS et al [16] and Rathod A K et al [17] who have reported patients of osteopetrosis who presented with fractures after trivial trauma. The common comorbidities seen in our patients included Anemia and carpal tunnel syndrome.…”

Section: Discussionmentioning

confidence: 99%

Management of femoral fractures in adult onset osteopetrosis: A multicentric retrospective study

Rahate¹,

Tarlekar²,

Jiwani³

et al. 2018

Int. J. Orthop. Sci.

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Background: Osteopetrosis is a relatively rare disease with an incidence of approximately 1 case per 2,00,000 to 5,00,000 population. The clinical features of osteopetrosis includes pathological fractures, severe anemia due to defective erythropoiesis, bone marrow failure, coagulation defects, propensity for developing severe infections. Common fractures seen in these patients include hip and femoral fractures. Management of fractures in these patients is technically difficult and postoperative complications are common. We conducted a retrospective study of 20 patients with osteopetrosis who presented with femoral fractures and were treated in our institute. Materials and Methods:This was a multicentric retrospective study of 20 patients with osteopetrosis who presented with femoral fractures. The patients were included in this study on the basis of predefined inclusion and exclusion criteria. The diagnosis was based upon imaging studies (X-Rays in all the patients and CT in selected cases). The operative procedure post-operative complications, functional outcome and complications during follow up were studied from case papers. The data was tabulated and analyzed using Minitab 17 version software. Results: Out of 20 studied cases there were 16 (80%) males and 4 (20%) females with a M:F ratio of 1: 0.25. The most common affected age group was found to be between 30 -35 years (35%). Majority of patient sustained fracture following motor vehicular accidents (65%) followed by fall from height (20%) and direct blow or assault (15%). 13 patients were found to be having co-morbidities including anemia, carpal tunnel syndrome and visual disturbances. Open reduction and internal fixation was done in all the cases. Technical difficulties seen during operative procedures included difficult because of obliterated canal, sclerosed medulla and dense swarf. Common complications in these patients included wound infection, hematoma formation and arthritis of hip joint (5%). Repeat surgeries were required in 3 (15%) patients and 1 (5%) patient developed non-union of the fracture ends. Conclusion: Management of femoral fracture in patients with osteopetrosis is challenging for operating orthopedic surgeon. Common problems encountered during open reduction and internal fixation include overheating during drilling, smoke production and increased temperature of both bone and drill bits and production of dense bone swarf. Orthopedic surgeon should be aware of these technical difficulties encountered during operative interventions.

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“…5 Most fractures in patients with OP are treated using conservative methods, including skeletal traction and plaster fixation, due to the high risks of infection and nonunion. 6 Technical challenges and complications may occur during surgery because of the hard but brittle bone structure. We report a patient with an osteopetrotic subtrochanteric fracture treated by open reduction and internal fixation with a dynamic hip screw (DHS).…”

Section: Introductionmentioning

confidence: 99%

<p>Subtrochanteric Femoral Fracture in a Patient with Osteopetrosis: Treated with Internal Fixation and Complicated by Intraoperative Femoral Neck Fracture</p>

Hua

Liu

Wang

2020

IJGM

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Objective Osteopetrosis (OP) is a rare, heritable skeletal disorder that is caused by osteoclast dysfunction, leading to failure of bone resorption and increased bone density. The fragility of such dense bone may result in an increased incidence of fractures. Furthermore, surgery in patients with OP is associated with increased technical difficulty and a higher risk of complications. Case Report We report a case of a 20-year-old woman with autosomal dominant OP who developed a subtrochanteric femoral fracture. The fracture was treated by open reduction and internal fixation using a dynamic hip screw. Although technical difficulties were experienced and an intraoperative femoral neck fracture occurred, the surgical outcome was satisfactory. Union of the fractures was visible on radiographs obtained 12 months postoperatively. At 2 years postoperatively, the patient was completely free of any complications resulting from her injury and treatment. Conclusion Open reduction and internal fixation may be an effective option for fractures in patients with OP. Orthopedic surgeons should be aware that the increased density and stiffness of osteopetrotic bone increases the risks of intraoperative technical difficulties, iatrogenic fractures, and postoperative complications.

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Traumatic multiple cervical spine injuries in a patient with osteopetrosis and its management

Abstract: The case report discusses rare occurrence of multiple level fractures of cervical spine following trivial injury to the neck in a patient with osteopetrosis and its treatment with conservative management.

Cited by 4 publications

References 7 publications

The Treatment of Subtrochanteric Fracture with Reversed Contralateral Distal Femoral Locking Compression Plate (DF‐LCP) Using a Progressive and Intermittent Drilling Procedure in Three Osteopetrosis Patients

The Treatment of Subtrochanteric Fracture with Reversed Contralateral Distal Femoral Locking Compression Plate (DF‐LCP) Using a Progressive and Intermittent Drilling Procedure in Three Osteopetrosis Patients

Management of femoral fractures in adult onset osteopetrosis: A multicentric retrospective study

<p>Subtrochanteric Femoral Fracture in a Patient with Osteopetrosis: Treated with Internal Fixation and Complicated by Intraoperative Femoral Neck Fracture</p>

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