{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T03:13:55Z","timestamp":1780110835228,"version":"3.54.0"},"reference-count":14,"publisher":"BMJ","issue":"9","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2023,8,17]]},"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:p>Pycnodysostosis is a rare genetic condition that leads to generalised bony sclerosis and increased fracture risk. Orthopaedic specialists play a crucial role in managing affected children due to their susceptibility to frequent fractures. We had a case of a middle childhood female patient with pycnodysostosis and a femur fracture. Initially, an attempt using the Titanium Elastic Nailing System was made, but the sclerotic metaphyseal bone made it challenging. So, we opted for a 4.5\u2009mm locked compressive plate, with multiple drill bits as a backup due to potential drill breakage. Though elastic nailing is preferred for paediatric long bone fractures, surgeons must be prepared for extremely sclerotic cortices and a narrow medullary canal when dealing with patients with pycnodysostosis. Open fixation and multiple drill bits in the toolkit are essential to overcome the potential obstacles during the procedure.<\/jats:p>","DOI":"10.1136\/bcr-2022-252667","type":"journal-article","created":{"date-parts":[[2023,9,18]],"date-time":"2023-09-18T22:50:29Z","timestamp":1695077429000},"page":"e252667","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Management of long bone fractures in patients with pycnodysostosis"],"prefix":"10.1136","volume":"16","author":[{"given":"Ajay","family":"Sharma","sequence":"first","affiliation":[{"name":"Orthopaedics, All India Institute of Medical Sciences, New Delhi, Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samarth","family":"Mittal","sequence":"additional","affiliation":[{"name":"Orthopaedics, All India Institute of Medical Sciences, New Delhi, Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vivek","family":"Trikha","sequence":"additional","affiliation":[{"name":"Orthopaedics, All India Institute of Medical Sciences, New Delhi, Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1386-1515","authenticated-orcid":false,"given":"Pulak","family":"Vatsya","sequence":"additional","affiliation":[{"name":"Orthopedic Surgery, Indraprastha Apollo Hospital, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,9,18]]},"reference":[{"key":"2025082722034312000_16.9.e252667.1","doi-asserted-by":"publisher","DOI":"10.1126\/science.273.5279.1236"},{"key":"2025082722034312000_16.9.e252667.2","first-page":"699","article-title":"Bone fracture and the healing mechanisms microdamage and microfracture","volume":"19","author":"Mori","year":"2009","journal-title":"Clin Calcium"},{"key":"2025082722034312000_16.9.e252667.3","first-page":"180","article-title":"A case of pycnodysostosis presented with pathological femoral shaft fracture","volume":"139","author":"Singh","year":"2014","journal-title":"Indian J Med Res"},{"key":"2025082722034312000_16.9.e252667.4","doi-asserted-by":"crossref","first-page":"5","DOI":"10.11604\/pamj.2020.35.5.8581","article-title":"Pycnodysostosis presented with tibial shaft fracture","volume":"35","author":"Mahmoudi","year":"2020","journal-title":"Pan Afr Med J"},{"key":"2025082722034312000_16.9.e252667.5","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1016\/S1297-319X(03)00143-X","article-title":"Subtrochanteric fracture managed by intramedullary nail in a patient with pycnodysostosis","volume":"71","author":"Kundu","year":"2004","journal-title":"Joint Bone Spine"},{"key":"2025082722034312000_16.9.e252667.6","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1007\/s00068-006-5085-6","article-title":"Diaphyseal femur fracture in pycnodysostosis treated with pennig wrist external fixator: a case study","volume":"32","author":"Jiya","year":"2006","journal-title":"Eur J Trauma"},{"key":"2025082722034312000_16.9.e252667.7","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1016\/j.jcot.2018.09.012","article-title":"A rare case of pycnodysostosis: technical difficulties in managing long bone fractures","volume":"11","author":"Romans","year":"2020","journal-title":"J Clin Orthop Trauma"},{"key":"2025082722034312000_16.9.e252667.8","doi-asserted-by":"crossref","first-page":"29","DOI":"10.21037\/jxym-22-19","article-title":"Surgical treatment, complications and preventive surgery of fractures in Pycnodysostosis: a systematic review","volume":"7","author":"Bocchi","year":"2022","journal-title":"J Xiangya Med"},{"key":"2025082722034312000_16.9.e252667.9","doi-asserted-by":"publisher","DOI":"10.1097\/BPB.0b013e328341bc6a"},{"key":"2025082722034312000_16.9.e252667.10","doi-asserted-by":"crossref","first-page":"1421","DOI":"10.1007\/s00590-018-2201-3","article-title":"TEN versus external fixator in the management of pediatric diaphyseal femoral fractures: evaluation of the outcomes","volume":"28","author":"Rollo","year":"2018","journal-title":"Eur J Orthop Surg Traumatol"},{"key":"2025082722034312000_16.9.e252667.11","doi-asserted-by":"crossref","unstructured":"Bisaccia M , Rinonapoli G , Di S , et al . 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