2025, Vol. 7, Issue 2, Part D
Surgical management of humeral non-union in pediatric osteopetrosis: A case report
Author(s): R Hariharasudhan, Lingaraju K and V Shreenidhi Nayaka
Abstract: Background: Osteopetrosis is a rare genetic bone disorder characterized by impaired osteoclastic bone resorption leading to increased bone density and susceptibility to fractures. Fracture non-union in osteopetrosis patients presents unique therapeutic challenges due to altered bone biology and technical surgical difficulties. While conservative management may be appropriate for certain pediatric cases, surgical intervention with rigid fixation and biological augmentation is often necessary for displaced fractures and established non-unions.
Case Presentation: An 8-year-old boy presented with a 2-year persistent deformity of the right proximal humerus following traumatic injury and initial TENS nail fixation. Implant removal 6 months prior resulted in pseudarthrosis. Physical examination revealed painless abnormal mobility at the non-union site with preserved joint motion. Laboratory investigations were normal, excluding infection and metabolic causes. Skeletal survey revealed characteristic osteopetrosis features: costochondral thickening, rugger jersey spine, Erlenmeyer flask deformity, bone-within-bone appearance, thickened skull cortices, and impaired dentition. Surgical management consisted of extended deltopectoral approach, debridement, corticocancellous bone grafting, and rigid fixation with locking reconstruction plate. Significant technical difficulty was encountered during drilling due to dense cortical bone.
Result: Histopathological examination confirmed osteopetrosis with irregular hyaline cartilage cores within woven and cortical bone. Three-cortex union was achieved at 10 weeks postoperatively. At 1-year follow-up, the surgical site healed completely without complications or deformity, and shoulder range of motion was symmetric with the contralateral side. The patient demonstrated excellent functional recovery and returned to age-appropriate activities.
Conclusion: Humeral non-union in pediatric osteopetrosis can be successfully managed with comprehensive skeletal evaluation to identify the underlying disorder, meticulous surgical technique employing locking plate fixation combined with biological augmentation, and structured postoperative rehabilitation. Recognition of osteopetrosis through characteristic radiographic features and histopathological confirmation enables appropriate surgical planning despite technical challenges inherent to osteopetrotic bone density.
DOI: 10.22271/27078345.2025.v7.i2d.292Pages: 227-232 | Views: 92 | Downloads: 33Download Full Article: Click Here
How to cite this article:
R Hariharasudhan, Lingaraju K, V Shreenidhi Nayaka.
Surgical management of humeral non-union in pediatric osteopetrosis: A case report. Int J Case Rep Orthop 2025;7(2):227-232. DOI:
10.22271/27078345.2025.v7.i2d.292
