PURPOSE OF THE STUDY. To assess if prolonged use of Bisphosphonates in Osteogenesis Imperfecta alters the pattern of femoral fractures. Osteogenesis Imperfecta (OI) has been treated with Bisphosphonates for many years with some clear clinical benefits. In adult cohorts there are reports of a new pattern of atraumatic subtrochanteric fractures seen with Bisphosphonate treatment. SUMMARY OF METHODS. This study assesses the location of femoral fractures in a cohort of 176 OI patients treated with Bisphosphonates over a two year period and compares it to a historical control group of 45 managed prior to the advent of this specific treatment. SUMMARY OF RESULTS. review of the radiological digital archive identified 16 femoral fractures in this time period in the Bisphosphonate treated group. All but 2 were within 5cm of the lesser trochanter, and 50% within 3cm. In comparison, the historical group, composed of 26 femoral fractures had a more widespread fracture pattern with the most frequent location being the mid-diaphysis. Many of the sub-trochanteric fractures in the treatment group occurred with minimal trauma, and in some cases without any injury. CONCLUSION. It appears that concerns in the adult osteoporotic population treated with Bisphosphonates are mirrored in Osteogenesis Imperfecta. It is possible that the high bending moments in the proximal femur together with altered mechanical properties of cortical bone secondary to the use of this group of drugs, mediated by abnormal osteoclast and osteoblast function, increase the risk of this type of injury and warrants further investigation

Aims

The aim of this study was to inform the epidemiology and treatment of slipped capital femoral epiphysis (SCFE).

We reviewed the long-term radiological outcome, complications and revision operations in 19 children with quadriplegic cerebral palsy and hip dysplasia who underwent combined peri-iliac osteotomy and femoral varus derotation osteotomy. They had a mean age of 7.5 years (1.6 to 10.9) and comprised 22 hip dislocations and subluxations. We also studied the outcome for the contralateral hip. At a mean follow-up of 11.7 years (10 to 15.1) the Melbourne cerebral palsy (CP) hip classification was grade 2 in 16 hips, grade 3 in five, and grade 5 in one. There were five complications seen in four hips (21%, four patients), including one dislocation, one subluxation, one coxa vara with adduction deformity, one subtrochanteric fracture and one infection. A recurrent soft-tissue contracture occurred in five hips and ten required revision surgery.

In pre-adolescent children with quadriplegic cerebral palsy good long-term outcomes can be achieved after reconstruction of the hip; regular follow-up is required.

Cite this article: Bone Joint J 2013;95-B:259–65.