ArticleOrthopedic reviews2026
osteopoikilosis and fracture healing: the bone quantity-quality paradox-a case report and systematic review with synthesis without meta-analysis.
Article in Orthopedic reviews, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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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 failures or delayed healing. Conclusion: Osteopoikilosis may mask underlying systemic osteoporosis, as evidenced by fractures occurring in the "spared" bone despite high BMD. TBS serves as a critical diagnostic safeguard to unmask this fragility. Clinically, however, the condition does not compromise biological repair; standard fracture management principles yield excellent outcomes without the need for modified fixation strategies.
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