Tayne Samantha, Smith Peter A
Department of Orthopaedic Surgery, University of Illinois at Chicago.
Department of Orthopaedic Surgery, Shriners Hospital for Children-Chicago, Chicago, IL.
J Pediatr Orthop. 2019 Aug;39(7):e558-e562. doi: 10.1097/BPO.0000000000001333.
Osteogenesis imperfecta (OI) is a hereditary disorder characterized by an abnormality of the quality or quantity of type I collagen, leading to bone fragility. Fractures in children with OI may result from minor trauma and have atypical patterns. Previous studies have found a strong relationship between olecranon fractures and OI in pediatric populations, but the characteristics of olecranon fractures within the OI patient population have not been fully described.
We reviewed the records of 358 children with a diagnosis of OI. Of those, 29 had at least 1 olecranon fracture. We collected general information relating to the patient's diagnosis of OI including OI type, fracture history, mobility, and bisphosphonate treatment. Information regarding the fracture, treatment, and the occurrence of bilateral fractures were recorded, as well as weight, height, and axial bone mineral density z-score from the time of the fracture.
Within our OI population of 358 patients, we found an incidence of olecranon fracture of 8.1% (29 patients). The olecranon fractures occurred predominantly in the type I population (27 of 29). Within the population of patients specifically with OI type I (200 patients) the incidence is 13.5%, with 6% of OI type I patients sustaining bilateral olecranon fractures. The percentage of children with one olecranon fracture subsequently sustaining another on the contralateral side was 41.4%. The mean time to the second fracture was 5 months. The mean age at the time of the first olecranon fracture was 11.9 years old. The average axial bone mineral density z-score was -2.5 for primary fractures. All 12 patients who suffered a contralateral olecranon fracture had OI type I.
Olecranon fractures in the OI population occur most commonly in patients with type I OI and during early adolescence, a period of rapid growth. There is a high rate of bilateral olecranon fractures, with the contralateral fracture occurring quickly after the primary fracture. Further studies may elucidate risk factors to determine which patients are most likely to fracture the contralateral side and therefore drive treatment and potentially prevention.
Level IV-retrospective cohort study.
成骨不全症（OI）是一种遗传性疾病，其特征为I型胶原蛋白的质量或数量异常，导致骨骼脆弱。OI患儿的骨折可能由轻微创伤引起，且具有非典型模式。既往研究发现小儿人群中鹰嘴骨折与OI之间存在密切关系，但OI患者群体中鹰嘴骨折的特征尚未得到充分描述。
我们回顾了358例诊断为OI的儿童的病历。其中，29例至少有1次鹰嘴骨折。我们收集了与患者OI诊断相关的一般信息，包括OI类型、骨折史、活动能力和双膦酸盐治疗情况。记录了有关骨折、治疗以及双侧骨折发生情况的信息，以及骨折时的体重、身高和轴向骨密度z评分。
在我们的358例OI患者群体中，我们发现鹰嘴骨折的发生率为8.1%（29例患者）。鹰嘴骨折主要发生在I型患者群体中（29例中的27例）。在特定的I型OI患者群体（200例患者）中，发生率为13.5%，6%的I型OI患者发生双侧鹰嘴骨折。一侧鹰嘴骨折的儿童随后对侧发生骨折的比例为41.4%。第二次骨折的平均时间为5个月。首次鹰嘴骨折时的平均年龄为11.9岁。初次骨折时的平均轴向骨密度z评分为-2.5。所有12例发生对侧鹰嘴骨折的患者均为I型OI。
OI患者群体中的鹰嘴骨折最常发生在I型OI患者以及青春期早期这一快速生长时期。双侧鹰嘴骨折的发生率很高，对侧骨折在初次骨折后很快发生。进一步的研究可能会阐明危险因素，以确定哪些患者最有可能发生对侧骨折，从而推动治疗并可能进行预防。
IV级——回顾性队列研究。
