Osteopetrosis is caused by general increase in bone density and obliteration of the medullary canal. Fractures are a frequent complication and their management is considered a challenge due to increased resistance to reaming and screw positioning; reduction maneuvers have to be done more carefully to avoid intraoperative fractures, and there is an increased risk of drill breakage. There is also a higher risk of infection and malunion, which increases the incidence of surgical revisions in this population.
55-year-old male with osteopetrosis and a history of two previous proximal femur fractures, who sustained an oblique supracondylar fracture of the left humerus and a simple, intra-articular, rotated fragment with capitelum involvement, as well as a fracture in the base of the coronoid process was admitted in our hospital. We performed an open reduction and internal fixation (ORIF) and 12 months after surgery, the patient’s bone has healed and he recovered flexion (110˚) and extension (−10˚) without complications.
During ORIF, two drill bits were broken and screw fixation was challenging due to the strength required. Bone overheating was also present during drilling, evidenced by smoke production and increased temperature of both bone and drill bits. Recommendations to avoid these problems include continuous cold saline irrigation, frequent drill bit changing, and spaced cycles with low-speed drilling. Additionally, high-resistance and high-speed electric drill bits can also be effective. Finally, patients should be closely followed postoperatively due to the high incidence of refracture, infection and malunion.
Fracture fixation in patients with osteopetrosis requires strategies to overcome the technical difficulties found during the procedure. Preoperative planning must include the availability of multiple metal drill bits, electric drills, and bone substitutes, having in mind drilling techniques, drilling speed, and temperature control. Patients should be closely followed to evidence any complications such as infections and malunions.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Price includes VAT (USA)
Tax calculation will be finalised during checkout.
Synthes, Inc. (West Chester, PA).
Bhargava A, Vagela M, Lennox CME (2009) “Challenges in the management of fractures in osteopetrosis”! Review of literature and technical tips learned from long-term management of seven patients. Injury 40(11):1167–1171
Fudge S, Amirfeyz R, Dimond D, Gargan M (2007) Marble bone disease. Curr Orthop 21(6):438–441
Del Fattore A, Cappariello A, Teti A (2008) Genetics, pathogenesis and complications of osteopetrosis. Bone 42(1):19–29
Schulz AS, Moshous D, Steward CG, Street UM, Kingdom U, Villa A. Osteopetrosis Consensus guidelines for diagnosis, therapy and follow-up. ESID EBMT. 2011;(Mi):1–33
Amit S, Shehkar A, Vivek M, Shekhar S, Biren N (2009) Fixation of subtrochanteric fractures in two patients with osteopetrosis using a distal femoral locking compression plate of the contralateral side. Eur J Trauma Emerg Surg 36(3):263–269
Landa J, Di Cesare P (2007) Management of the patient with osteopetrosis. J Am Acad Orthop Surg 15:654–662
Armstrong DG, Newfield JT, Gillespie R (1999) Orthopedic management of osteopetrosis : results of a survey and review of the literature summary. J Pediatr Orthop 19:122–132
Sen RK, Gopinathan NR, Kumar R, Saini UC (2013) Simple reproducible technique in treatment for osteopetrotic fractures. Musculoskelet Surg 97(2):117–121
Gupta RK (2005) Long bone fractures in osteopetrosis: awareness of primary pathology and appropriate pre-operative planning necessary to avoid pitfalls in fixation. Inj Extra 36(3):37–41
Conflict of interest
The authors report no conflicts of interest.
About this article
Cite this article
Farfán, M.A., Olarte, C.M., Pesantez, R.F. et al. Recommendations for fracture management in patients with osteopetrosis: case report. Arch Orthop Trauma Surg 135, 351–356 (2015). https://doi.org/10.1007/s00402-014-2144-z
- Supracondylar fracture
- Intra-articular fractures