Hoellwarth JS, Edmonds EW. Difficult Management of a Femur Fracture in a Patient with Dyskeratosis Congenita: A Literature Review and Case Report.
JBJS Case Connect 2021;
11:e20.00486. [PMID:
33882034 DOI:
10.2106/jbjs.cc.20.00486]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE
A 14-year-old boy with dyskeratosis congenita (DKC), status-post unrelated bone marrow transplant (BMT), sustained a femoral shaft fracture. Despite immediate fixation with the widest possible titanium elastic nails, fixation construct rigidity was insufficient and malunion occurred with refracture 5 years later. Revision fixation with rigid intramedullary nailing has maintained position for 1 year, although callus formation remains meager.
CONCLUSION
This is the first article to detail fracture care for a DKC patient. Although BMT increases lifespan, patients seemingly remain skeletally frail. Rigid intramedullary fixation is optimally durable and appears hematopoietically safe. Long-term follow-up is recommended.
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