Treatment of Osteopetrosis-Related Subtrochanteric Fracture Using the Ilizarov Compression-Distraction Device: A Case Report

Abstract

Submit Manuscript | http://medcraveonline.com (ADO 2) which displays end-plate thickening of the verterbrae "rugger-jersey spine" and the endobones "bone-within-bone" radiographic appearance of the pelvis. ADO 2 patients are usually asymptomatic and are diagnosed either incidentally or while presenting with a fracture as although the density increases, the mechanical strength is decreased [5]. Literature has documented various treatment options-surgical and conservative, with their respective outcomes [3][4][5][6][7]. The common feature noted is the difficulty faced intra-operatively due to the hard, dense bone resulting in equipment failure, prolonged surgery, suboptimal fixations and complications to the patient-blood loss, tissue and bone damage. We report a case of ADO 2 which was fixed using the ICD device with a good outcome Case ReportA 26 year lady, a known case of ADO 2, was referred to our center following a fall at home one month earlier. Her district hospital team had suggested a trial of conservative treatment, but due to the persistent pain and discomfort of immobilization she requested for surgical intervention. Despite sustaining the injury a month earlier, she was still suffering from substantial pain. Radiographs showed a subtrochanteric fracture of the left femur-Seinsheimer 2A without healing callus. After ruling out other injuries, skin traction was applied. The treatment options and all possible complications-intra, immediate and delayed post-operative were explained to her and the family. A collective decision was made to apply an ICD as we aimed to minimize operative time, reduce possible damage to tissue and bone, and limit surgical scarring. The necessary pre-operative investigations were done, and optimized where needed.After spinal anesthesia was administered, she was placed on a traction table and under an image-intensifier a closed manual reduction was attempted to reduce the displacement as much as possible. But as expected, the proximal segment was significantly displaced upward-flexed and externally rotated. The decision was made to apply the ICD framework, and use the components to reduce the fracture-a benefit of the ICD system. 1.8 millimeter Russian made biocompatible olive wires and 5.0 millimeter tapered schanz pins were inserted based on the safe zones followed by the rings and arches. The initial deformity was well reduced in the coronal plane but was unsatisfactory in the sagittal plane. Taking into account the duration of the injury-specifically the contracted surrounding muscles, we applied a translation device for a gradual and controlled reduction. This also prevented the necessity of an open reduction, thus minimizing operative time, preventing blood loss, and the risk of fracture propagation if we had tried re-manipulation. Post-operatively the limb was clinically well-aligned (Figures 1 & 2).The total surgical time was about 50 minutes. There was negligible blood loss as only stab incisions were made for the schanz pins entry. Post-operative pain was well managed ...