Management of pathological fracture in patients with primary hyperparathyroidism

Primary hyperparathyroidism due to parathyroid adenoma is sporadic in nature and seldom symptomatic. Patients usually present with pathological fractures. The objective of this study was to diagnose primary hyperparathyroidism in patients presenting with pathological neck of femur fractures, detection of the adenoma or ectopic tissue, removal of the tissue, and treatment of the fracture. All patients presenting with pathological fracture neck of femur, with clinical features suggestive of hyperparathyroidism were investigated for blood calcium, alkaline phosphatase, parathyroid hormone. If found to be raised patients underwent nuclear scan for detection of primary hyperparathyroidism. Primary hyperparathyroidism (usually parathyroid adenoma) when found was excised. After 2 weeks fixation of fracture was done. Follow-up at 6 weeks, 12 weeks, 6 months, 1 year were done. Time to radiological union, functional assessment and other systemic complaints were noted. Nine patients were included in the study as they presented with pathological fracture due to hyperparathyroidism. All except 1 were due to parathyroid adenoma. Excision of the tumour with early fracture fixation lead to quick rehabilitation of the patient. All fractures united. Hyperparathyroidism is asymptomatic in many patients, and may present only with a fracture. Orthopaedicians should keep this possibility in mind while diagnosing these cases, failure to which may result in disastrous complications.