Neck of Femur Fracture in Young Patients With End-Stage Renal Disease and Hyperparathyroidism: A Report of Three Cases and Proposed Treatment Algorithm

Abstract

Secondary hyperparathyroidism is a complication arising from untreated end-stage renal disease (ESRD). It can invariably lead to osteoporosis and subsequently cause pathological neck of femur (NOF) fracture. Despite being young, osteosynthesis in neck of femur fractures of these patients often leads to nonunion and implant failure due to severely osteoporotic bone. We present our experience in managing three young patients with ESRD and secondary hyperthyroidism who sustained NOF fractures. All three patients were successfully treated and showed no complication at one year post-operation. Based on our experience and literature review, we propose a simple algorithm to guide the management of these patients.

Keywords: bipolar hemiarthroplasty; end stage renal disease (esrd); hyperparathyroid; neck of femur fracture; pathological fracture; total hip replacement (thr); young adults.

Figure 1. Right hip plain radiographs in Case 1 show intracapsular neck of femur fracture immediately after trauma (1A), post-parathyroidectomy (1B) and after right hip bipolar hemiarthroplasty (1C).

Figure 2. Left hip plain radiographs in Case 1 show intracapsular neck of femur fracture immediately after trauma (2A) and after cancellous screw fixation (2B).

Figure 3. Right hip plain radiographs of the patient in Case 2 show intracapsular neck of femur fracture immediately after trauma (3A), failure of cancellous screw fixation two months post-operation (3B), post-parathyroidectomy (3C) and post-total hip replacement (3D).

Figure 4. Pelvic plain radiographs of the patient in Case 3 show non-union of right neck of femur (NOF) fracture and non-displaced left intracapsular NOF fracture (4A). She underwent right total hip replacement and left cancellous screw fixation (4B).

Figure 5. A simple algorithm is proposed to guide the management of neck of femur fracture in young patients with end-stage renal failure and secondary hyperparathyroidism.