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(A)
(B)
(C)
(D)
(E)
FIGURE 44.6
Nineteen-year-old with type I OI with multiple injuries including a Galeazzi fracture, distal tibial pilon fracture and burst
fracture L3 with acute cauda equina syndrome while a restrained passenger “joy riding” with three friends when the car rolled. None of the
other young men sustained any significant injuries. (A, B, C) Lateral scout view, coronal and axial CT scan demonstrating the retropulsion and
collapse of the vertebral body. (D, E) Six-year follow-up with complete neurologic recovery following acute anterior decompression and fixation.
their peers with normal bone for all types of fractures,
including significant spinal fractures with sometimes
relatively trivial trauma. They also appear to be more
willing to take risks than those with more severe forms
of OI and are more likely to be involved in high energy
activities such as motor vehicle accidents because they
tend to be in more unsupervised mainstream activi-
ties with their peers than those with more severe forms
of OI. The mechanism of injury may be deceptive as
these injuries can occur with a relatively low energy
accident. Operative treatment may need to be consid-
ered, especially in older individuals with burst frac-
tures or other injuries with spinal cord compression
(
Figure 44.6
).
12
Operative treatment may also need to
be considered with significant loss of anterior verte-
bral height in a more mature individual. Kyphoplasty
has been reported in one 58-year-old male patient with
type I OI who sustained a significant L2 compression
fracture. This procedure cannot be recommended as a
routine treatment based on one patient and has signifi-
cant potential risks.
31
Segmental fixation has improved
as has the strength of the bone in these individuals
as a result of treatment with bisphosphonates, which
may improve the stability and effectiveness of fixation
in these patients.
15,16,32
However, there is no clear-cut
guidance from the literature as to how to approach
these individuals, who do require operative treatment
for their fractures.
