Parathyroidectomy restored bone mineral density in a neglected femoral neck fracture with renal osteodystrophy: A case report

Figure 1 Anteroposterior view of the initial hip X-ray after the fall. It shows no obvious right femoral neck fracture. Note that the cortical thickness of diaphysis was similar bilaterally.

Figure 2 Patellar avulsion fracture status post open reduction internal fixation with cerclage wire. A: Lateral view; B: Anteroposterior view.

Figure 3 Intraoperative view of the right achilles tendon rupture.

Figure 4 A hip X-ray 1 year after the fall. It showed a neglected (blue arrow) right femoral neck fracture and marked cortical thinning of the right femoral diaphysis compared with the left (orange arrow) due to stress-shielding.

Figure 5 Computed tomography of the hip 1 year after the fall. It showed a right femur neck fracture (blue arrow) with osteitis fibrosa cystica in the bilateral femoral heads (yellow arrows).

Figure 6 Hip X-rays. A: Hip X-ray shows thin cortical bone (blue arrow) at the time the fracture occurred; B: Hip X-ray 3 years after subtotal parathyroidectomy and 2 years after right hip replacement shows solid union of the fracture (yellow arrow), with restoration of the cortical bone thickness (white arrow).

Figure 7 Bone mineral density 8 months after subtotal parathyroidectomy and 2 months after right total hip replacement. A: Vertebral body; B: Left femoral neck. BMD: Bone mineral density.

Figure 8 Bone mineral density 3 years after subtotal parathyroidectomy and 2 years after right total hip replacement. A: Vertebral body; B: Left femoral neck, note that bone mineral density of the lumbar spine (L1-L4) increased by 59%. BMD: Bone mineral density.

Figure 9 Timeline of the clinical course. PTX: Parathyroidectomy; THR: Hip replacement ; BMD: Bone mineral density.