Olecranon Fractures in Pediatric Patients With Osteogenesis Imperfecta
Samantha Tayne1, Peter A Smith2
1Department of Orthopaedic Surgery, University of Illinois at Chicago.
Insights
Osteogenesis imperfecta (OI) patients, particularly those with type I, have a high incidence of olecranon fractures, often bilateral and occurring in early adolescence. Further research is needed to identify risk factors for contralateral fractures.
Area of Science:
- Pediatric Orthopedics
- Genetics and Rare Diseases
- Skeletal Dysplasias
Background:
- Osteogenesis imperfecta (OI) is a genetic disorder affecting collagen, leading to brittle bones and frequent fractures in children.
- Olecranon fractures are a known complication in pediatric OI, but their specific characteristics remain under-described.
Purpose of the Study:
- To characterize olecranon fractures in children diagnosed with Osteogenesis Imperfecta.
- To investigate the incidence, fracture patterns, and associated factors of olecranon fractures within the OI population.
Main Methods:
- Retrospective cohort study of 358 children with OI.
- Analysis of fracture history, OI type, treatment, and occurrence of bilateral olecranon fractures.
- Inclusion of patient demographics, bone mineral density, and fracture-related data.
Main Results:
- Olecranon fractures occurred in 8.1% of the OI cohort (29 patients), predominantly in type I OI (27/29).
- In OI type I patients, olecranon fracture incidence was 13.5%, with 6% experiencing bilateral fractures.
- 41.4% of patients with one olecranon fracture sustained a contralateral fracture within a mean of 5 months; all were OI type I.
Conclusions:
- Olecranon fractures in OI are most common in type I, occurring during early adolescence.
- A significant rate of bilateral olecranon fractures is observed, with rapid contralateral fracture occurrence.
- Further research into risk factors for contralateral fractures is crucial for targeted treatment and prevention strategies.
Background:
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.
Methods:
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.
Results:
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.
Conclusions:
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 Of Evidence:
Level IV-retrospective cohort study.
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