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      Case report: A 10 years follow-up of periprosthetic femoral fracture after total hip arthroplasty in osteopetrosis

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          Abstract

          Osteopetrosis is an inherited disorder characterized by increased bone density and brittle bone quality. Degenerative changes often occur after the age of 40 in patients with osteopetrosis. Operative intervention is the primary treatment option if the clinical manifestation of secondary osteoarthritis is severe. A 44-year-old male suffering autosomal dominant osteopetrosis and progressive unilateral hip osteoarthritis required a total hip arthroplasty. However, there were several technical challenges associated with this procedure including creating a femoral medullary canal and developing a Vancouver type B2 periprosthetic femoral fracture postoperatively. To afford some experience for the management of similar cases, we here present our technical solutions to these problems.

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          Fractures of the femur after hip replacement.

          B Masri, Julia Duncan (1994)
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            Osteopetrosis.

            Jakub Tolar, Steven Teitelbaum, Paul Orchard (2004)
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              Osteopetrosis. Current clinical considerations.

              F. Shapiro (1993)
              Osteopetrosis is an inherited skeletal condition characterized by increased bone radiodensity. There are three clinical groups: infantile-malignant autosomal recessive, fatal within the first few years of life (in the absence of effective therapy); intermediate autosomal recessive, appears during the first decade of life but does not follow a malignant course; and autosomal dominant, with full-life expectancy but many orthopaedic problems. The infantile variant shows a myelophthisic anemia, granulocytopenia, and thrombocytopenia, and patients eventually die from infection or bleeding or both. Neurologic sequelae include cranial nerve compression (optic nerve, blindness; auditory nerve, deafness; facial nerve, paresis), hydrocephalus, convulsions, and mental retardation. Radiographs show uniform bone density without corticomedulary demarcation, broadened metaphyses, "bone within a bone" or endobone phenomena (tarsals, carpals, phalanges, vertebra, ilium), and thickened growth plates if there is superimposed rickets. Transverse pathologic fractures occur, often followed by massive periosteal bone formation. Computed tomographic scans, magnetic resonance imaging, and bone scans provide specific information. Iliac crest bone biopsy is valuable to quantitate osteoclast and marrow changes by light and electron microscopy. Medical treatments involve high-dose calcitriol to stimulate osteoclast differentiation and bone marrow transplantation to provide monocytic osteoclast precursors. Orthopaedic problems in the intermediate and autosomal dominant forms include increased fractures, coxa vara, long-bone bowing, hip and knee degenerative arthritis, and mandibular and long-bone osteomyelitis. Cranial nerve compression also occurs. Osteotomy, plating, intramedullary rodding, and joint arthroplasty can be done, but are difficult because of bone hardness.
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                Author and article information

                Contributors
                Zhan-Feng Zhang
                Journal
                Journal ID (nlm-ta): Chin J Traumatol
                Journal ID (iso-abbrev): Chin. J. Traumatol
                Title: Chinese Journal of Traumatology
                Publisher: Elsevier
                ISSN (Print): 1008-1275
                Publication date PMC-release: 10 May 2017
                Publication date (Print): June 2017
                Publication date (Electronic): 10 May 2017
                Volume: 20
                Issue: 3
                Pages: 173-176
                Affiliations
                [a ]Department of Orthopaedic Surgery, The First People's Hospital of Huzhou, Huzhou, Zhejiang, 313000, China
                [b ]Department of Orthopaedic Surgery, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, 310009, China
                Author notes
                [∗ ]Corresponding author. 15905720901@ 123456163.com
                Article
                Publisher ID: S1008-1275(16)30184-5
                DOI: 10.1016/j.cjtee.2017.02.001
                PMC ID: 5473737
                PubMed ID: 28550971
                SO-VID: 583ac71f-670b-4d67-9793-60bdfe1eb2bb
                Copyright © © 2017 Daping Hospital and the Research Institute of Surgery of the Third Military Medical University. Production and hosting by Elsevier B.V.
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date received : 30 May 2016
                Date revision received : 2 September 2016
                Date accepted : 5 April 2017
                Categories
                Subject: Case Report

                Keywords: osteopetrosis,arthroplasty, replacement, hip,periprosthetic femoral fractures
                Data availability:
                Keywords: osteopetrosis, arthroplasty, replacement, hip, periprosthetic femoral fractures

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