Forearm nonunion caused by hyperparathyroidism with 7 years follow up: A case report

Abstract

Introduction: We report a patient who developed nonunion of both bones of the forearm associated with hyperparathyroidism (HPT).

Presentation of case: The patient was a 71-year-old female who previously fell and hit her left hand on the ground. At 2 years after injury the patient visited our hospital, since she became aware of instability of the left forearm without an inducer due to nonunion of the radioulnar diaphysis. The patient was surgically treated to acquire forearm support. Surgery for nonunion was applied only to the ulna. To acquire an elbow joint flexion angle, an about 30° angle was added to the false joint region. At one year after surgery, blood testing suggested HPT, however, the parathyroid mass was not excised following the current guidelines for management of HPT. At 7 years after surgery, the elbow range of motion, VAS and the Q-DASH score were improved. Weight-bearing by the forearm became possible, and the patient can perform pronation and supination at the radial nonunion.

Discussion: We learned from this case that it is necessary to immediately perform close examination to identify the presence or absence of primary disease causing insufficiency fracture, such as HPT. For treatment of nonunion of the 2 forearm bones in this elderly female, osteosynthesis of the ulna alone achieved sufficient osteal support without osteosynthesis of the radius, and the postoperative course was favorable.

Conclusion: We presented here a rare case of nonunion of both bones of the forearm associated with HPT.

Keywords: Forearm nonunion; Hyperparathyroidism; Osteoporosis; Parathyroid hormone.