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Primary hyperparathyroidism presenting as delayed fracture union

  • Sports Traumatology
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

We describe a case of delayed union in a tibial fracture secondary to primary hyperparathyroidism. A closed intra-articular proximal tibia fracture was stabilized with a hybrid external fixator. At 5 months clinical and radiological evaluation failed to demonstrate evidence of fracture healing. Fixation was stable and inflammatory markers ruled out infection. Further questioning revealed symptoms of anorexia, nausea and constipation. Plasma biochemistry showed an elevated corrected calcium and parathyroid hormone concentration. Further investigation included a sestamibi scan which confirmed a diagnosis of hyperparathyroidism secondary to a parathyroid adenoma. Six weeks following partial parathyroidectomy the fracture site was pain free, non-tender and the fracture had united radiologically. In cases of delayed-union, once an infective cause has been excluded with a mechanically stable fracture, other causes of delayed union like primary hyperparathyroidism should be ruled out.

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References

  1. Court-Brown C, McBirnie J (1995) The epidemiology of tibial fractures. J Bone Joint Surg 77-B:417–421

    Google Scholar 

  2. Dempster DW, Hughes-Begos CE, Plavetic-Chee K et al (2005) Normal human osteoclasts formed from peripheral blood monocytes express PTH type 1 receptors and are stimulated by PTH in the absence of osteoblasts. J Cell Biochem 18:139–148. doi:10.1002/jcb.20388

    Article  Google Scholar 

  3. Gani NU (2008) More than two years delay. Cases J 1:61. doi:10.1186/1757-1626-1-61

    Article  PubMed  Google Scholar 

  4. Juliano JS, Juliano PJ (2000) Hyperparathyroidism presenting as a nonunion of the femur: case report and review of the literature. Mil Med 165:569–571

    PubMed  CAS  Google Scholar 

  5. Lancourt JE, Hochberg F (1977) Delayed fracture healing in primary hyperparathyroidism. Clin Orthop Relat Res 124:214–218

    PubMed  Google Scholar 

  6. Marshall W (2000) Clinical chemistry, vol 3. Mosby, Oxford, pp 183–200

    Google Scholar 

  7. Martinez A, Sarmiento A, Latta LL (2003) Closed fractures of the proximal tibia treated with a functional brace. Clin Orthop Relat Res 417:293–302

    PubMed  Google Scholar 

  8. O’Riordan JLH (1978) Hormonal control of mineral metabolism. In: O’Riordan JLH (ed) Recent advances in endocrinology and metabolism, vol 1. Churchill Livingstone, Edinburgh, pp 194

    Google Scholar 

  9. Silverberg SJ, Shane E, Jacobs TP, Siris E, Bilezikian JP (1999) A 10-year prospective study of primary hyperparathyroidism with or without parathyroid surgery. N Engl J Med 341:1249–1255. doi:10.1056/NEJM199910213411701

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Trauma and Orthopaedics, North Hampshire Hospitals Foundation NHS Trust, Aldermaston Road, Basingstoke, Hampshire, RG24 9NA, UK

    P. S. Sauvé & I. G. I. Suliman

  2. Imperial College School of Medicine, London, UK

    J. D. Calder

Authors
  1. P. S. Sauvé
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  2. I. G. I. Suliman
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  3. J. D. Calder
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Correspondence to P. S. Sauvé.

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Sauvé, P.S., Suliman, I.G.I. & Calder, J.D. Primary hyperparathyroidism presenting as delayed fracture union. Knee Surg Sports Traumatol Arthrosc 17, 551–554 (2009). https://doi.org/10.1007/s00167-009-0753-9

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  • DOI: https://doi.org/10.1007/s00167-009-0753-9

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