Treatment of subtrochantric femur fracture with intra-medullary nailing (IMN) in a patient with osteopetrosis: A case report and literature review.

INTRODUCTION AND IMPORTANCE

Osteopetrosis is a rare hereditary bone disorder characterized by defective osteoclastic bone resorption, leading to dense but brittle bones. These structural abnormalities predispose patients to fractures and complicate orthopedic surgeries due to obliterated medullary canals and increased cortical density. Subtrochanteric femoral fractures in such patients are rare and challenging, with limited consensus on optimal surgical management.

CASE PRESENTATION

We present a 45-year-old male with adult-onset autosomal dominant osteopetrosis who sustained bilateral subtrochanteric femoral fractures-first on the right side, then on the left two years later. Both fractures were managed with intramedullary nailing (IMN). The procedures were technically demanding due to the sclerotic bone and canal obliteration, requiring sequential drilling and reaming with irrigation to prevent thermal necrosis. Both fractures healed without complications, with radiographic union at 9 months and early mobilization.

CLINICAL DISCUSSION

IMN in osteopetrotic bone is technically difficult but feasible with meticulous planning and technique. Reported complications include drill bit breakage, thermal injury, delayed union, and hardware failure. Compared to extramedullary fixation, IMN offers better mechanical stability in weight-bearing regions. Our experience aligns with other reports suggesting IMN is a viable approach when performed with necessary precautions. The lack of standardized protocols necessitates individualized planning based on anatomical and clinical considerations.

CONCLUSION

This case highlights the successful application of IMN for subtrochanteric fractures in adult osteopetrosis, emphasizing the importance of surgical expertise. Further studies are needed to guide standardized management in this rare condition.