Ten pseudofractures and six complete fractures occurred in five patients
with adult hypophosphatasia. The four pseudofractures that were treated
non-operatively progressed to complete fracture. The six pseudofractures
and six complete fractures that were treated by internal fixation united.
New fractures occurred in four patients after the removal of the internal
fixation. We recommend that complete fractures, symptomatic
pseudofractures, and progressive asymptomatic pseudofractures in patients
with adult hypophosphatasia be treated with load-sharing internal-fixation
devices, such as rigid intramedullary nails. These should not be removed
unless it is absolutely essential. If removal is necessary, however, they
should be replaced, preferably during the same anesthetic session. In our
opinion, the guidelines developed from this study may be applied reasonably
to patients with osteomalacia from causes other than hypophosphatasia,
especially if medical therapy has been unsuccessful.