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Topic:

Osteogenesis Imperfecta

Issue:

​

Category:

Congenital

Title:

Iatrogenic Intraoperative Fracture in Patients With Osteogenesis Imperfecta

Author:

Georgiadis, Andrew G. MD; Pottinger, Todd J. BS; Sigrist, Emmalynn J. DO; Truong, Walter H. MD

Journal:

Journal of Pediatric Orthopaedics

Date:

November/December 2024

Reference:

44(10): p e945-e950, DOI: 10.1097/BPO.0000000000002778

Level Of Evidence:

IV

# of Patients:

60

Study Type:

Retrospective cohort study

Location:

Single OI referral center

Summary:

This study investigates the rate of iatrogenic intraoperative fractures in pediatric patients with osteogenesis imperfecta (OI) during orthopedic surgery. It finds that iatrogenic fractures occur in 18.3% of patients undergoing surgery, primarily in the femur, and frequently require alterations in postoperative care.

Methods:

Review of patients with OI treated between 2013 and 2023. All patients who underwent orthopedic surgery were examined for intraoperative fractures. Data collected included OI subtype, surgery details, complications, Clavien-Dindo classification, and outcomes.

Exclusions:

None specified

Results:

11 out of 60 patients (18.3%) experienced an unplanned, iatrogenic intraoperative fracture. 15 fractures occurred during 356 surgical episodes (4.2%). Most fractures (11/15) occurred in the femur and were related to the removal, insertion, or exchange of intramedullary implants in the lower extremity. 13 out of 15 fractures (87%) were classified as Clavien-Dindo II or III, indicating a need for postoperative care modifications or additional interventions. Iatrogenic fractures were the most common intraoperative complication in this cohort.

Conclusions:

Iatrogenic fractures during orthopedic surgery for OI are common, with the majority occurring in the femur. These fractures typically require modifications to postoperative rehabilitation and additional treatments. The risk should be discussed with families during informed consent.

Relevance:

Limitations:

Perspective:

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