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Creating Rigidly Stabilized Fractures for Assessing Intramembranous Ossification, Distraction Osteogenesis, or Healing of Critical Sized Defects
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Fracture Patterns Differ Between Osteogenesis Imperfecta and Routine Pediatric Fractures

Kranti V Peddada1, Brian T Sullivan, Adam Margalit

  • 1Department of Pediatric Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD.

Journal of Pediatric Orthopedics
|January 23, 2018
PubMed

Insights

Certain fracture patterns in children may indicate osteogenesis imperfecta (OI). Transverse and diaphyseal humerus fractures, along with olecranon fractures, are most indicative of OI, aiding in early diagnosis.

Area of Science:

  • Pediatric Orthopedics
  • Medical Genetics
  • Skeletal Dysplasias

Background:

  • Osteogenesis imperfecta (OI) is a genetic disorder affecting bone fragility.
  • Accurate diagnosis of OI, particularly mild Type 1, is crucial for appropriate management.
  • Estimating the likelihood of OI in pediatric fractures is clinically significant.

Purpose of the Study:

  • To determine the association between specific fracture patterns and the likelihood of osteogenesis imperfecta (OI) in pediatric patients.
  • To identify radiographic indicators that can help differentiate OI fractures from typical pediatric fractures.

Main Methods:

  • Retrospective review of 29,101 pediatric fracture cases (2003-2015).
  • Inclusion criteria excluded fractures from major trauma, and OI cases identified via ICD-9 codes.
  • Comparison of fracture characteristics between 52 OI patients and 500 randomly sampled non-OI controls.

Main Results:

  • OI patients were younger at fracture (mean 5.5 years) than non-OI patients (mean 9.0 years).
  • OI patients showed higher rates of oblique, transverse, diaphyseal, and bilateral long-bone fractures.
  • Non-OI patients had more buckle, metaphyseal, and physeal fractures. Transverse humerus, olecranon, and diaphyseal humerus fractures had high likelihood ratios for OI.

Conclusions:

  • Specific fracture patterns, including transverse and diaphyseal humerus and olecranon fractures, are strongly associated with OI.
  • Conversely, physeal and supracondylar humerus fractures are less indicative of OI.
  • Radiographic fracture analysis is a valuable tool for assessing the probability of OI in pediatric cases.
Abstract

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