A 41-years-old patient came to our observation for a subtrochanteric nonunion after a femural fracture; the patient was affected with osteogenesis imperfecta type III associated with severe skeletal malformations such as convex chest-lumbar scoliosis, cardiomegaly and pelvic deformity. Moreover she presented a severe hypometria of the contralateral leg (about 20 cm) associated with an important extrarotation and varism of the residual femural neck and clinodactyly. Surgical treatment consisted in the removal of the old broken fixation plate, pathological tissue cruentation, lateral 35° cuneiform resection. After a correct reduction we completed the fixation with a new osteosynthesis using AO LCP Synthes plate with trochanteric hooks and 8 screw, than we implanted growth factors (rh-BMP-7), autologous mesenchymal cells and a double massive allogenic bone graft. The postoperative course was regular. After 60 days a radiograph showed an initial healing of the fracture. Clinically, functional recovery of the operated limb was good, allowing the patient good mobility. After 3 months, a great healing progression was evident on CT control scans, with stable fixation and a correct alignment.
Non-unions are always challenging for the orthopaedic surgeon, frequently leading to severe and disabling deformity; this is much more true in this complex case, with a patient affected by osteogenesis imperfecta. Biotechnology, namely the use of human recombinant morphogenetic proteins (rhBMP-7) with autologous mesenchymal cells implant, represents not only a valid biological supplementation, already validated by international studies, but also a big opportunity for healing.