Intramedullary Canal-creation Technique for Patients with Osteopetrosis

We present details of a surgical technique to create an intramedullary canal to allow intramedullary fracture fixation in patients with osteopetrosis. Clinical cases are used to facilitate the description.

Osteopetrosis is a rare, hereditary condition characterised by hard, brittle, "marble bone;" primarily due to osteoclast dysfunction. Patients are prone to fractures and subsequently nonunions, periprosthetic fractures, and metal-ware failure are commonly seen. Due to the increased bone density, deformity, and obliteration of the medullary cavity, fracture fixation is also technically demanding.

Creation of a medullary canal allows the use of intramedullary fixation rather than plate and screws for long-bone fractures.

A new sharp drill bit should be used for each case as blunt drills are more likely to break.Bone is drilled in a pulsatile fashion, with withdrawal every 2-4 seconds for bone swarf to be removed.Constant cooling of the drill bit with saline to help prevent bone necrosis and drill breakage.Regular exchanging of drill bit sizes to expand the canal. The smaller drills start the canal and are used to direct progress. Sequential expansion during canal creation is preferred.Regular use of orthogonal radiographs to ensure correct canal positioning and prevent perforation.

The creation of an intramedullary canal allows intramedullary fracture fixation. In our experience, this technique gives the orthopaedic surgeon a safe and effective method for treating long-bone fractures in patients with osteopetrosis.

Fractures and nonunions in patients with osteopetrosis are difficult to manage; and by detailing this technique, a further option is now available for surgeons when deciding upon fixation method.

Kent J, Ferguson D. Intramedullary Canal-creation Technique for Patients with Osteopetrosis. Strategies Trauma Limb Reconstr 2019;14(3):155-162.