BACKGROUND This case report contributes to the medical literature by highlighting the successful management of a neglected femoral neck fracture in a patient with renal osteodystrophy and secondary hyperparathyroidism...BACKGROUND This case report contributes to the medical literature by highlighting the successful management of a neglected femoral neck fracture in a patient with renal osteodystrophy and secondary hyperparathyroidism(SHPTH)who was on dialysis due to end-stage renal disease(ESRD).It underscores the efficacy of parathyroidectomy(PTX)in restoring bone mineral density(BMD)and promoting fracture healing,addressing a significant complication in ESRD patients.CASE SUMMARY A 36-year-old female with renal osteodystrophy and on dialysis due to ESRD presented with a history of left patellar tendon rupture and later,a right achilles tendon avulsion fracture.Persistent right hip pain led to the discovery of a neglected right femoral neck fracture,which was initially overlooked due to the patient’s complex medical history.Two months post-achilles tendon repair,the patient underwent PTX to manage the refractory SHPTH.The postoperative course included rehabilitation and weight-bearing exercises.Remarkably,2 years after osteosynthesis,radiographic assessments indicated a solid union of the periprothesis fracture and significant improvement in BMD,showcasing the efficacy of the treatment approach.CONCLUSION PTX,combined with appropriate rehabilitation,is crucial for improving BMD and fracture healing in ESRD patients with SHPTH.展开更多
Secondary hyperparathyroidism (HPT) is frequent in dialysis patients. Parathyroidectomy (PTX) is indicated for patients who failed medical therapy. We reviewed the data from 184 dialysis patients who underwent PTX bet...Secondary hyperparathyroidism (HPT) is frequent in dialysis patients. Parathyroidectomy (PTX) is indicated for patients who failed medical therapy. We reviewed the data from 184 dialysis patients who underwent PTX between January 2015 and January 2023. We aimed to evaluate the short and long term outcomes of PTX in dialysis patients, comparing the conservative 3/4 versus 7/8 techniques in this population.166 dialysis patients with secondary HPT were included. A conservative subtotal PTX (sPTX) 7/8 was performed in 72% of patients and sPTX 3/4 in 28% of them. Severe postoperative hypocalcaemiaocurred in 45 patients (27%). Hypocalcaemia was significantly more frequent in the sPTX 7/8 group (p = 0.012). One case of persistent HPT (0.6%) and 20 cases of recurrence (12%) were diagnosed. Recurrence was more frequent in the sPTX 3/4 group (15%). No deaths were reported during the perioperative period.展开更多
文摘BACKGROUND This case report contributes to the medical literature by highlighting the successful management of a neglected femoral neck fracture in a patient with renal osteodystrophy and secondary hyperparathyroidism(SHPTH)who was on dialysis due to end-stage renal disease(ESRD).It underscores the efficacy of parathyroidectomy(PTX)in restoring bone mineral density(BMD)and promoting fracture healing,addressing a significant complication in ESRD patients.CASE SUMMARY A 36-year-old female with renal osteodystrophy and on dialysis due to ESRD presented with a history of left patellar tendon rupture and later,a right achilles tendon avulsion fracture.Persistent right hip pain led to the discovery of a neglected right femoral neck fracture,which was initially overlooked due to the patient’s complex medical history.Two months post-achilles tendon repair,the patient underwent PTX to manage the refractory SHPTH.The postoperative course included rehabilitation and weight-bearing exercises.Remarkably,2 years after osteosynthesis,radiographic assessments indicated a solid union of the periprothesis fracture and significant improvement in BMD,showcasing the efficacy of the treatment approach.CONCLUSION PTX,combined with appropriate rehabilitation,is crucial for improving BMD and fracture healing in ESRD patients with SHPTH.
文摘Secondary hyperparathyroidism (HPT) is frequent in dialysis patients. Parathyroidectomy (PTX) is indicated for patients who failed medical therapy. We reviewed the data from 184 dialysis patients who underwent PTX between January 2015 and January 2023. We aimed to evaluate the short and long term outcomes of PTX in dialysis patients, comparing the conservative 3/4 versus 7/8 techniques in this population.166 dialysis patients with secondary HPT were included. A conservative subtotal PTX (sPTX) 7/8 was performed in 72% of patients and sPTX 3/4 in 28% of them. Severe postoperative hypocalcaemiaocurred in 45 patients (27%). Hypocalcaemia was significantly more frequent in the sPTX 7/8 group (p = 0.012). One case of persistent HPT (0.6%) and 20 cases of recurrence (12%) were diagnosed. Recurrence was more frequent in the sPTX 3/4 group (15%). No deaths were reported during the perioperative period.
