Management of Combined Fracture Neck of Femur and Femoral Deformity in Osteogenesis Imperfecta Patient: A Case Report

Abstract

Osteogenesis imperfecta (OI) patients usually sustain repeated fractures from trivial trauma and also have skeletal deformities that affect walking. The bone fragility and repeated fractures produce deformities of the long bones especially in femur and tibia. However, neck of femur (NOF) fractures in OI are rarely described. A 11-year-old male patient known to have OI (Sillence type IV) sustained a NOF fracture after a fall. He also had proximal femoral anterolateral bowing proximally and over an intramedullary (IM) rod inserted 4 years back. He was treated by corrective osteotomy and stabilisation with an IM telescoping nail for the deformed femur and the Wagner technique for the NOF fracture. One year after operation, the patient had recovered satisfactory functional outcome with union of the NOF fracture and correction of the femoral deformity.

Conclusion: The method of the Wagner technique can achieve stable fixation for femoral neck fractures and introduces the least interference with concurrent telescoping nail insertion.

How to cite this article: Elbaseet HM, Ibrahim AH, Abol Oyoun N, et al. Management of Combined Fracture Neck of Femur and Femoral Deformity in Osteogenesis Imperfecta Patient: A Case Report. Strategies Trauma Limb Reconstr 2024;19(1):56-59.

Keywords: Fracture neck of femur; Osteogenesis imperfecta; Proximal femoral deformity; Telescoping nail; Wagner technique.

Figs 1A to C

(A) Anteroposterior long X-ray film showing mid-cervical NOF fracture and intracortical rod migration in both femurs. Note varus malalignment at proximal third of right femur; (B and C) Lateral views showing flexion deformity on the right side

Fig. 2

Three-dimensional CT scan showing no comminution at NOF fracture

Fig. 3

Intraoperative C arm images after telescopic nail insertion

Fig. 4

Anteroposterior long X-ray at 1-year follow-up showing union of NOF fracture

Figs 5A to E

(A and B) Schematic diagram of preoperative planning. Detection of CORA at proximal femur; (C) Fixation of NOF fracture by two threaded guide wires and anterolateral based wedge excision; (D) Insertion of male and female components of telescoping nail; (E) Bending of guide wires parallel to the shaft and wrapping two cerclages around them