osteopoikilosis and fracture healing: the bone quantity-quality paradox-a case report and systematic review with synthesis without meta-analysis
Abstract
Introduction: Osteopoikilosis is a rare sclerosing bone dysplasia that may mimic osteoblastic metastases and complicate fracture assessment. Its influence on bone quality, fixation stability, and fracture healing remains unclear.
Objective: To report a tibial plateau fracture in a patient with osteopoikilosis and systematically synthesize published evidence on fracture characteristics, management, and healing outcomes in osteopoikilosis.
Methods: We integrated an index case with a systematic review and synthesis without meta-analysis. The index case involved a 66-year-old woman with a Schatzker type II tibial plateau fracture and incidental osteopoikilosis, evaluated using dual-energy X-ray absorptiometry (DXA), trabecular bone score (TBS), and ¹⁸F-NaF PET/CT. A systematic literature search through January 2026 synthesized fracture characteristics and healing outcomes.
Results: In the index case, the fracture occurred within intervening bone, sparing sclerotic lesions. This localization revealed a bone quantity-quality paradox: sclerotic lesions artifactually elevated BMD, whereas low TBS identified underlying systemic fragility. The systematic review (N=11) demonstrated fractures across the axial and appendicular skeletons, including both upper and lower extremities. Management ranged from conservative care to operative fixation with intramedullary nails, locking plates, and headless cannulated screws. Fracture union was consistently achieved, with no reported technical…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 11 participants or records.
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