Serial drilling technique for sequential subtrochanteric femur fracture fixation in pediatric osteopetrosis: a technical report

Pediatric osteopetrosis presents a significant technical challenge for fracture fixation due to the bone's dense yet brittle nature and frequently absent medullary canal. Traditional drilling methods risk excessive torque, drill-bit breakage, and iatrogenic fractures. Here, we describe a serial drilling technique for plate-and-screw fixation in a 5-year-old child with osteopetrosis who sustained sequential subtrochanteric femur fractures 8 months apart. By creating a small pilot hole, sequentially enlarging it with intermediate bits under copious irrigation, and inserting locking screws manually, we achieved stable fixation with no observed instrument failure or intraoperative complications. This method may provide a practical technical strategy for surgeons managing similarly dense osteopetrotic bone.