title: Primary hyperparathyroidism presenting as delayed fracture union.
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.
authors.affiliation: Department of Trauma and Orthopaedics, North Hampshire Hospitals Foundation NHS Trust, Basingstoke, Hampshire, UK. philsauve@doctors.org.uk
authors.forename: P S
authors.initials: PS
authors.lastname: Sauvé
authors.forename: I G I
authors.initials: IG
authors.lastname: Suliman
authors.forename: J D
authors.initials: JD
authors.lastname: Calder
mesh_terms: D000236:Adenoma / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D002118:Calcium / Q000097:blood; D016267:External Fixators; D005260:Female; D005592:Fracture Fixation / Q000295:instrumentation / Q000379:methods; D017102:Fracture Healing; D005599:Fractures, Ununited / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D010282:Parathyroid Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D016105:Parathyroidectomy; D011859:Radiography; D013978:Tibial Fractures / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery
chemical_list: D010281:Parathyroid Hormone; D002118:Calcium