Department of Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstr. 200a, 69118, Heidelberg, Germany.
Department of Diagnostic and interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.
Orthopadie (Heidelb). 2022 Dec;51(12):1015-1021. doi: 10.1007/s00132-022-04278-x. Epub 2022 Jul 8.
Treatment of femoral neck fractures secondary to osteopetrosis is an uncertain and puzzled decision. Experience in the treatment, especially in the pediatric population, is scarcely reported. The duration of conservative treatment is prolonged and poses the risks of non-union and development of coxa vara deformity. The recommended treatment is closed reduction and internal fixation; however, surgery on osteopetrotic bone is challenging due to defective bone marrow function, delayed consolidation and higher risk of intraoperative fractures. Slipped capital femoral epiphysis secondary to osteopetrosis is very rarely reported. This article presents the case of a 5-year-old female patient with rapidly deteriorating physical function due to bilateral proximal femoral Salter-Harris type II fractures with associated slippage of the growth plates secondary to confirmed autosomal recessive osteopetrosis. Operative treatment was performed in a tertiary level orthopedic center with closed reduction and internal fixation with cannulated screws. A loss of fixation with coxa vara deformity was seen on the left side 7 months postoperatively with increasing pain. A revision surgery with reosteosynthesis and a valgus osteotomy was thus performed which showed good subjective and objective results 1 year postoperatively with complete bony union.
治疗成骨不全症继发股骨颈骨折是一个不确定且令人困惑的决策。治疗经验,特别是在儿科人群中,几乎没有报道。保守治疗的持续时间延长,存在不愈合和发展成髋内翻畸形的风险。推荐的治疗方法是闭合复位和内固定;然而,由于骨髓功能缺陷、延迟愈合和术中骨折风险较高,对成骨性骨进行手术具有挑战性。继发于成骨不全症的股骨头滑脱非常罕见。本文介绍了一例 5 岁女性患者的病例,该患者因双侧股骨近端 Salter-Harris Ⅱ型骨折伴生长板滑脱而导致双侧股骨近端 Salter-Harris Ⅱ型骨折伴生长板滑脱,功能迅速恶化,经证实为常染色体隐性成骨不全症。在三级骨科中心进行了手术治疗,采用空心螺钉闭合复位和内固定。7 个月后,左侧出现固定丢失和髋内翻畸形,疼痛加重。因此,进行了翻修手术,再次进行骨合成和外翻截骨术,术后 1 年随访显示主观和客观结果良好,完全骨性愈合。