Management of Multilevel Mid-Cervical Fractures in an Adult With Osteopetrosis
Bibliographic record
Abstract
Osteopetrosis is a rare inherited osteoclast dysfunction disorder that produces bone that is both abnormally dense and brittle, complicating fracture management and internal fixation. Most cervical spine injuries reported in osteopetrosis involve the craniovertebral junction (C1-C2) and are treated surgically because of presumed instability. Reports of multilevel mid-cervical fractures with ligamentous injury successfully treated nonoperatively are exceedingly scarce. We present the case of a 22-year-old man with longstanding osteopetrosis who sustained high-energy trauma resulting in a displaced posterior-inferior C4 body fracture with associated left C4 lateral-mass involvement, nondisplaced left C3 inferior-facet and C6 pedicle fractures, and magnetic resonance imaging (MRI) evidence of focal cord T2 signal, posterior longitudinal ligament injury, and a small epidural hematoma. Despite this constellation - which, in normal bone, would often mandate operative stabilization - the patient remained neurologically intact, with acceptable alignment and negative vascular imaging. Given the unique surgical hazards of osteopetrotic bone (poor screw purchase, intraoperative fracture risk, delayed union), conservative management was chosen using a rigid cervical orthosis (Miami J®, Ossur ehf., Reykjavik, Iceland) and serial imaging follow-up. At 1 year, flexion-extension computed tomography demonstrated complete osseous bridging of the C3 facet and C4 body fractures, partial but stable bridging across the C4 facet and lamina and preserved alignment. The patient remained asymptomatic and neurologically intact. This case expands the evidence base for nonoperative management of cervical fractures in adult osteopetrosis beyond C1-C2 patterns. It highlights that rigid-collar immobilization, when neurological function and alignment are preserved and vascular injury is excluded, can yield stable union without surgery. Flexion-extension computed tomography provides a practical endpoint, supporting acceptance of stable partial radiographic healing when dynamic stability is maintained.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".