Fixation Procedures of The Proximal Third Femur in Patients With Osteogenesis Imperfecta: Location, Location, and...

Area of Science:

• Orthopedic Surgery
• Pediatric Orthopedics
• Bone Metabolism Disorders

Background:

• Osteogenesis imperfecta (OI) presents unique challenges for proximal femur fracture and osteotomy fixation.
• Accurate classification and risk factor identification are essential for managing these complex cases.

Purpose of the Study:

• To evaluate surgical fixation outcomes for proximal femur fractures and osteotomies in OI patients.
• To classify femoral neck fractures in OI using modern systems.
• To identify risk factors associated with complications.

Main Methods:

• Multi-center retrospective study of 43 OI patients with proximal femur fixation and ≥12 months follow-up.
• Radiographic and clinical data analysis, including reduction quality and healing assessment.
• Statistical analysis using Mann-Whitney U and Fisher Exact tests to identify risk factors.

Main Results:

• Femoral neck fractures (18 cases) showed a 72.2% complication rate, 33.3% nonunion, and 55.6% revision rate, with Pauwels type and reduction quality as significant risk factors.
• Intertrochanteric/subtrochanteric fractures/osteotomies (35 cases) had a 35.1% complication rate and 5.4% nonunion rate, with a 32.4% revision rate, often occurring post-initial healing.
• All patients eventually achieved union.

Conclusions:

• Femoral neck fractures in OI patients are associated with high complication, nonunion, and reoperation rates.
• Higher Pauwels type and poorer initial reduction quality increase complication risk.
• Intertrochanteric/subtrochanteric procedures have lower nonunion but significant revision rates, necessitating patient counseling.