Title : Valgizing osteotomy with DHS for bilateral neglected pathologic femur neck fractures in young patient: A case report
Abstract:
Background: Bilateral femur neck fractures after a low energy trauma in a young adult patient are extremely rare and almost always indicate underlying metabolic bone pathology. Parathyroid adenoma causes primary hyperparathyroidism which causes widespread skeletal depletion thereby exposing a patient to a low energy or atraumatic fractures.
Case presentation: A 21-year-old female presented after sustaining a fall down injury from a standing height. Radiographs revealed bilateral displaced femur neck fractures. Workup confirmed primary hyperparathyroidism with elevated parathyroid hormone (1702pg/ml), total serum calcium (19.28mg/dl) and ionized calcium (9.32mg/dl); neck ultrasound showed localized parathyroid mass
Management and Outcome: The patient first underwent focused parathyroidectomy followed by medical optimization for post-operative ‘hungry bone syndrome’. The femur neck fractures were managed with staged bilateral valgizing intertrochanteric osteotomies and fixation using dynamic hip screws. At 6 months union was achieved bilaterally with retained implant position; no evidence of avascular necrosis; restored bone quality and pain free mobility.
Conclusion: Low energy bilateral femur neck fractures in young patients can be the initial presentation of frequently asymptomatic parathyroid adenoma. Multi-disciplinary approach involving focused parathyroidectomy, metabolic correction, and carefully planned and executed valgizing osteotomy with dynamic hip screw can restore mobility in delayed cases.
