Acetabular fracture and central hip dislocation in osteogenesis imperfecta child treated surgically with bone grafts augmented by recombinant human bone morphogenetic protein-2: A rare case report

Bintang Soetjahjo; Denny Adriansyah; Ahmad Fauzan; Benedictus Anindita Satmoko

doi:10.1016/j.ijscr.2023.108436

Acetabular fracture and central hip dislocation in osteogenesis imperfecta child treated surgically with bone grafts augmented by recombinant human bone morphogenetic protein-2: A rare case report

Int J Surg Case Rep. 2023 Jul:108:108436. doi: 10.1016/j.ijscr.2023.108436. Epub 2023 Jun 22.

Authors

Bintang Soetjahjo¹, Denny Adriansyah², Ahmad Fauzan³, Benedictus Anindita Satmoko⁴

Affiliations

¹ Orthopedic and Traumatology Department, dr. Moewardi General Hospital, Surakarta, Indonesia. Electronic address: bjortho@staff.uns.ac.id.
² Orthopedic and Traumatology Department, dr. Moewardi General Hospital, Surakarta, Indonesia.
³ Faculty of Medicine, Sebelas Maret University, Surakarta, Indonesia.
⁴ Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia.

Abstract

Introduction and importance: Rare congenital disorder osteogenesis imperfecta (OI) can make treating complex acetabular fractures-dislocations challenging. Open reduction and internal fixation (ORIF) with locking plates and screws may not produce satisfactory results. We present the outcome of ORIF with reconstruction locking plate and screw augmented by bone grafts with recombinant bone morphogenetic protein-2 (rhBMP-2) for OI type I child with Judet-Letournel both column type acetabular fracture associated with central hip dislocation.

Case presentation: We present a case of a 13-year-old female OI type I patient with right hip pain after falling while biking. Both eyes had blue sclera and OI family history. Intraoperatively, the Stoppa approach was used. Proximal femoral skeletal traction was used to reduce the femoral head and aid bone graft reconstruction of the acetabular wall. Intraosseous injection of rhBMP-2 was added. Fractures were fixed with a curved reconstruction locking plate and screws. Bones and soft tissues were gently manipulated to prevent blood loss. Radiographic and functional results were remarkable.

Clinical discussion: Fractures and blood loss are more likely to occur in OI type I patients due to collagen type I deficiency. Proximal femur skeletal traction is crucial for ORIF plating in acetabular fractures with central hip dislocation. This minimizes bone and soft tissue manipulation. RhBMP-2-injected bone grafts have structural support and osteoinductive properties that enhance bone healing. Despite its exceptional results in this case, further research is needed.

Conclusion: The combination of our technique and rhBMP-2 effectively accelerates bone healing in OI patient treated with ORIF.

Keywords: Acetabular fracture; Case report; Central hip dislocation; Open reduction internal fixation; Osteogenesis imperfecta; Recombinant human bone morphogenetic-2.

Publication types

Case Reports