Open reduction and internal fixation using a locking compression plate as treatment for subtrochanteric fracture in two patients with osteopetrosis

• Published in: Injury 2020-02, Vol.51 (2), p.565-569
• Main Authors: Hiyama, Shuhei, Takahashi, Tsuneari, Matsumura, Tomohiro, Takeshita, Katsushi
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Bone Plates; Bone Screws; Female; Fracture Fixation, Internal - methods; Fracture Healing; Hip Fractures - complications; Hip Fractures - diagnostic imaging; Hip Fractures - surgery; Humans; Lateral decubitus position; Locking compression plate; Male; Middle Aged; Open Fracture Reduction - methods; Osteopetrosis; Osteopetrosis - complications; Osteopetrosis - diagnostic imaging; Radiography; Recovery of Function; Retrospective Studies; Subtrochanteric fracture; Treatment Outcome; Young Adult
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/j.injury.2019.11.032

•We followed up patients with osteopetrosis having subtrochanteric fractures for at least 72 months post-surgery.•We propose that there is a greater need for anatomic reduction when treating subtrochanteric fracture in patients with osteopetrosis.•We recommend the surgical option involving internal fixation with a locking plate that is conducted in the lateral decubitus position. Osteopetrosis is a heritable disease characterized by the dysfunction of osteoclasts, resulting in decreased bone resorption and increased bone density. Fractures are a common complication of osteopetrosis, which are challenging for orthopedic surgeons to treat because the condition renders canal reaming and screw placement difficult. Data of patients with osteopetrosis from 2011 to 2019, which were available from an electronic medical database, were retrospectively analyzed. Inclusion criteria were patients with osteopetrosis having subtrochanteric fractures who were followed up for at least 72 months; 2 patients were identified. Case 1 was a 38-year-old male and Case 2 was a 79-year-old female. Both had left subtrochanteric fractures identified using X-ray that were classified as AO 32-A3.3 and AO 31-A3.3 and treated by open reduction and internal fixation using a reversed distal femoral locking compression plate (DePuy Synthes, Obedors, Switzerland). For Case 1, fracture union was confirmed 8 months after surgery and the patient recovered the ability to walk independently using a cane, which was consistent with his pre-injury functioning. Complications were not observed during the 7-year follow-up period. For Case 2, fracture union was confirmed 9 months after surgery. She was able to walk using a crutch, which was consistent with her pre-injury functioning. Complications were not observed during the 8-year follow-up period. We propose that there is a greater need for anatomic reduction when treating subtrochanteric fracture in patients with osteopetrosis. In order to address this issue, we recommend the surgical option involving internal fixation with a locking plate that is conducted in the lateral decubitus position. This position could benefit patients with osteopetrosis having proximal femoral fractures because anatomic reduction and plate stabilization minimize the potential injury to the abductor mechanism.