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CLINICAL IMAGE
Year : 2020  |  Volume : 152  |  Issue : 7  |  Page : 231

Crippled woman with bilateral femur fracture


Department of Orthopedics, All India Institute of Medical Sciences, Bhubaneswar 751 019, Odisha, India

Date of Submission20-Nov-2019
Date of Web Publication25-May-2021

Correspondence Address:
Bishnu Prasad Patro
Department of Orthopedics, All India Institute of Medical Sciences, Bhubaneswar 751 019, Odisha
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmr.IJMR_2390_19

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How to cite this article:
Patro BP, Varghese P. Crippled woman with bilateral femur fracture. Indian J Med Res 2020;152, Suppl S1:231

How to cite this URL:
Patro BP, Varghese P. Crippled woman with bilateral femur fracture. Indian J Med Res [serial online] 2020 [cited 2021 Jul 29];152, Suppl S1:231. Available from: https://www.ijmr.org.in/text.asp?2020/152/7/231/316846

Patient's consent obtained to publish clinical information and images


A 23 yr old female presented to the department of Orthopedics, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India, on October 19, 2019 with a fracture of both femurs following a trivial fall 28 days back. The patient was completely bedridden and was put on skin traction till evaluated. Radiographs revealed pathological fracture of both femurs in the sub-trochanter region and punctate lesions in the skull [Figure 1]. Serum parathyroid hormone level was 1803 ng/dl (normal: 10-65 ng/dl); and serum alkaline phosphatase significantly elevated to 1031 U/l (normal: 100-290 U/l). Serum ionized calcium was 1.51 mmol/l (normal: 1-1.4 mmol/l) and serum phosphate was 2.0 mg/dl (normal: 2.5-5 mg/dl). Bone scan revealed increased uptake of the whole skeleton; polyostotic fibrous dysplasia. The diagnosis made was parathyroid adenoma with hyperparathyroidism leading to pathological fracture. Following confirmation of diagnosis, parathyroid glands were removed partially and serum calcium level stabilized. The patient was operated for fracture of the sub-trochanter region. The fracture in the right femur was fixed on December 23, 2018 and that of left femur on January 4, 2019 with an intramedullary nail as per anaesthetic fitness [Figure 2]A. Both femurs united well in the due course of time [Figure 2]B. Patient was prescribed calcium supplementation and high protein diet along with open chain and isotonic exercises. In a follow up after one year, the patient was leading a normal life with no recurrence.
Figure 1: Fracture of the left and right femurs (yellow arrows), and punctate lesion of the skull (red arrows).

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Figure 2: (A) Immediate post-operative radiograph with implant in situ (yellow arrow) and (B) fracture completely healed at one year (red arrows).

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    Figures

  [Figure 1], [Figure 2]



 

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