Điều trị phẫu thuật gãy bệnh lý đầu trên xương đùi do bệnh xương hóa đá: báo cáo trường hợp và nhìn lại y văn

Osteopetrosis is a rare hereditary disease characterized by abnormally increased bone density, leading to brittle bones and a high propensity for pathological fractures, particularly in critical weight-bearing areas like the proximal femur. These fractures present significant clinical challenges due to the unique bone properties associated with osteopetrosis, including delayed healing and increased risk of complications during surgical intervention. Understanding effective treatment modalities for such complex cases is crucial for improving patient outcomes. This report aims to contribute to the existing knowledge by detailing the surgical management of pathological proximal femur fractures in osteopetrosis patients and providing a comprehensive review of relevant literature.

Orthopedic surgeons, trauma specialists, researchers in bone metabolic diseases, and medical residents seeking to understand and manage complex pathological fractures in patients with osteopetrosis.

This paper investigates the surgical treatment of pathological fractures of the proximal femur in patients diagnosed with osteopetrosis, a rare hereditary condition marked by abnormally increased bone density and subsequent bone fragility. Such fractures present significant clinical challenges due to the unique bone properties associated with osteopetrosis, including delayed healing and increased risk of complications during surgical intervention. The study presents three clinical cases from the Hospital for Traumatology and Orthopaedics at Ho Chi Minh City, where patients with osteopetrosis-related proximal femur fractures underwent successful surgical fixation using locking plates and screws. Despite the inherent challenges in operating on osteosclerotic bone, such as difficulties in drilling, increased bleeding, and the potential for delayed union or infection, all three cases demonstrated favorable outcomes with good bone healing and functional recovery, averaging a healing time of one year. The discussion further elaborates on the characteristics of osteopetrosis, emphasizing the increased fracture risk and the extended healing periods compared to conventional fractures, often requiring longer periods of restricted weight-bearing. It also reviews various surgical approaches and their considerations, such as the debate around intramedullary nailing versus plating and the limited evidence for bone grafts in these patients. The findings suggest that with meticulous surgical technique, careful patient selection, and comprehensive postoperative management, internal fixation using locking plates and screws can be an effective and successful treatment for pathological proximal femur fractures in osteopetrosis patients, thereby contributing valuable insights for improving clinical practice in this complex orthopedic subspecialty.