Sauvé P S, Suliman I G I, Calder J D
Department of Trauma and Orthopaedics, North Hampshire Hospitals Foundation NHS Trust, Basingstoke, Hampshire, UK.
Knee Surg Sports Traumatol Arthrosc. 2009 May;17(5):551-4. doi: 10.1007/s00167-009-0753-9. Epub 2009 Mar 3.
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.
我们描述了一例继发于原发性甲状旁腺功能亢进的胫骨骨折延迟愈合病例。一名闭合性关节内近端胫骨骨折患者采用混合式外固定架进行固定。5个月时，临床和影像学评估均未显示骨折愈合迹象。固定稳定，炎症指标排除了感染。进一步询问发现患者有厌食、恶心和便秘症状。血浆生化检查显示校正钙和甲状旁腺激素浓度升高。进一步检查包括锝[99mTc]甲氧基异丁基异腈扫描，证实诊断为甲状旁腺腺瘤继发甲状旁腺功能亢进。甲状旁腺部分切除术后六周，骨折部位无疼痛、无压痛，影像学显示骨折已愈合。在延迟愈合的病例中，一旦排除感染原因且骨折机械稳定，应排除其他导致延迟愈合的原因，如原发性甲状旁腺功能亢进。
