Subtrochanteric fractures in osteopetrosis; report of two cases with conservative and operative management

In osteopetrosis subtrochanteric area is especially vulnerable to get fractured as it is an area of concentrated stress. We describe two cases of autosomal dominant osteopetrosis with subtrochanteric fractures. In one case upper tibial pin track infection prompted us towards a conservative management with a successful outcome in a time span of 25 weeks. The second case was directly treated by dynamic hip screw fixation though with great difficulty but was complicated by poor callus formation and loosening of implant. Re intervention was done with change of implant and bone grafting with subsequent fracture union. Both the cases experienced a second subtrochanteric fracture in their opposite hips after an average time period of 6 years and were managed operatively. Our experience with these two cases makes us to believe that there can be no clear cut protocol for the management of subtrochanteric fractures in osteopetrosis. Conservative management can still be considered when operative treatment is not an option. On the other hand, operative treatment is associated with considerable difficulty and complications. We thus have to weigh our options accordingly.