Injury, Int. J. Care Injured 33 (2002) 84–85
Case report
Hip fracture in adult osteopetriosis
D. Hay, C.A. Pailthorpe *
Orthopaedic Department, Royal Berkshire Hospital, London Road, Reading RG1 5AN, UK
Accepted 15 August 2000
in May 1999, he had no right hip pain and a man-
ageable ache on the left (Fig. 2).
1. Introduction
Schonberg [1] first described osteopetriosis in 1904.
It is a rare condition characterised by the failure of
osteoclasts to resorb and remodel new bone [2]. The
bone is dense, hard and brittle. In the adult ‘benign’
form, fractures are usually single, isolated and trans-
verse [3].
3. Conclusion
The management of femoral fractures in osteo-
petriosis is complicated by the characteristics of the
bone with resultant decrease in the medullary canal
diameter. Techniques such as intramedullary nailing
[4] and total hip replacement [5] have been used in
fractures around the hip. Most reports comment on
the difficulty in reaming the intramedullary canal.
This case illustrates that an extramedullary device
maybe a safer option in this situation.
2. Case history
In 1992, a 45-year-old man known to have os-
teopetriosis sustained
a transverse subtrochanteric
fracture of his left femur after falling off a bicycle on
holiday. He underwent internal fixation of the frac-
ture with a Zickel Nail. At operation the femoral
medullary canal was absent and reaming it to 14.5
mm took 3 h. As the nail was inserted, the proximal
femur fractured longitudinally. This was held together
with two partridge wires and the rest of the operation
had to be abandoned (Fig. 1). His postoperative re-
covery was long and complicated remaining in skele-
tal traction for 3 months. Seventeen months after
insertion, the original nail was exchanged for a
Kuntscher nail because of severe buttock pain due to
the prominent proximal end (Fig. 1). He was dis-
charged from follow up, 3 months later.
In 1997, the same patient fell against machinery at
work and sustained a similar subtrochanteric fracture
of the right femur. This was internally fixed using a
Dynamic Cortical Screw and plate. The operation
took a total of 2 h and 30 min. Postoperative recov-
ery was uncomplicated and he was fully weight bear-
ing after 4 months. At the time of his last follow up
Fig. 1.
* Corresponding author.
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