Locking plate osteosynthesis for a femoral fracture in a pt
Osteopetrosis is a skeletal disorder characterized by increased osteodensity and a remodeling defect. The fragility of dense sclerotic bones may lead to an increased incidence of fractures. Although internal fixation can be performed, technical challenges may be experienced because of the increased bone density. Complications such as delayed union, nonunion, or implant failure may occur postoperatively.

Published in the International Journal of Surgery Case Reports, the authors describe a patient with autosomal-dominant osteopetrosis type 2 who suffered a shaft fracture below a plate of his right femur.

Osteosynthesis was performed with a single locking plate. Union was delayed, and plate breakage occurred along with nonunion of the fracture. The nonunion was addressed using double locking plates, which secured fixation and allowed complete fracture healing.

Learning Points:-
• There were three reasons of nonunion in this case.

• First, the authors left gaps between the fragments.

• Second, they used mainly cerclage wires, rather than screws, for plate fixation, which led to inadequate stability. Third, the patient was large (height 167 cm, weight 93.1 kg), so the single plate provided insufficient fixing force.

• They then used double locking plates and attained stronger internal fixation with complete fracture healing.

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