Kinoshita Mayuko, Naito Kiyohito, Aritomi Kentaro, Sugiyama Yoichi, Nagura Nana, Goto Kenji, Iwase Yoshiyuki, Kaneko Kazuo
Department of Orthopaedics, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
Department of Orthopaedics, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
Int J Surg Case Rep. 2017;38:158-162. doi: 10.1016/j.ijscr.2017.07.032. Epub 2017 Jul 21.
We report a patient who developed nonunion of both bones of the forearm associated with hyperparathyroidism (HPT).
The patient was a 71-year-old female who previously fell and hit her left hand on the ground. At 2 years after injury the patient visited our hospital, since she became aware of instability of the left forearm without an inducer due to nonunion of the radioulnar diaphysis. The patient was surgically treated to acquire forearm support. Surgery for nonunion was applied only to the ulna. To acquire an elbow joint flexion angle, an about 30° angle was added to the false joint region. At one year after surgery, blood testing suggested HPT, however, the parathyroid mass was not excised following the current guidelines for management of HPT. At 7 years after surgery, the elbow range of motion, VAS and the Q-DASH score were improved. Weight-bearing by the forearm became possible, and the patient can perform pronation and supination at the radial nonunion.
We learned from this case that it is necessary to immediately perform close examination to identify the presence or absence of primary disease causing insufficiency fracture, such as HPT. For treatment of nonunion of the 2 forearm bones in this elderly female, osteosynthesis of the ulna alone achieved sufficient osteal support without osteosynthesis of the radius, and the postoperative course was favorable.
We presented here a rare case of nonunion of both bones of the forearm associated with HPT.
我们报告一例发生前臂双骨骨不连并伴有甲状旁腺功能亢进症（HPT）的患者。
该患者为一名71岁女性，此前曾摔倒，左手着地受伤。受伤后2年，患者因尺桡骨干骨不连，在无诱因情况下自觉左前臂不稳定，遂来我院就诊。对患者进行手术治疗以获得前臂支撑。骨不连手术仅应用于尺骨。为获得肘关节屈曲角度，在假关节区域增加约30°的角度。术后1年，血液检查提示HPT，但按照当前HPT的管理指南，未切除甲状旁腺肿物。术后7年，肘关节活动范围、视觉模拟评分（VAS）和上肢功能障碍与残疾问卷（Q-DASH）评分均有所改善。前臂能够负重，患者在桡骨骨不连处可进行旋前和旋后动作。
我们从该病例中认识到，有必要立即进行仔细检查，以确定是否存在导致不全骨折的原发性疾病，如HPT。对于该老年女性前臂双骨骨不连的治疗，仅对尺骨进行骨固定就获得了足够的骨质支撑，而无需对桡骨进行骨固定，且术后病程良好。
我们在此展示了一例罕见的与HPT相关的前臂双骨骨不连病例。
