Endocrine Abstracts

Patient J, b. 1963 sent to an endocrinologist by a traumatologist due to the lack of consolidation of a fracture of the right ankle with complaints of pain, restriction of movements in the right ankle joint.

Medical history: 09/19/2018 suffered a combined fracture of the lower leg bones when falling from a height of their own growth after falling at home falling from a height of their own growth. Reposition was performed, a circular plaster cast was applied, immobilization in a cast until 11.24.2018. Moved with crutches. 12/24/2018 repeated fall, upon examination by a traumatologist and control radiography – no fresh fracture was detected.

Conclusion unconsolidated fracture of the external ankle, partially consolidated fracture of the medial ankle and posterior edge of the right tibia from 09/19/2018 with subluxation of the foot outward. Contracture. T–score L1–L4 = –2.61 blood electrolytes – normal, PTH 34, 25 (OH) D 13.1, B–crosslaps– 0.848, P1NP 20.3, osteocalcin <2.0, calcitonin – <2.0.

MSCT 01/07/2019: Fractures of the distal parts of the bones of the right lower leg are determined: Unconsolidated fragmentary fracture of the lateral ankle, with diastasis of bone fragments up to 5 mm. The edges of the bone fragments are uneven, sometimes sclerotic. Improperly fused fracture of the medial ankle, with diastasis in the anterior sections up to 4 mm. The edges of the fragments are clear, sclerotic, consolidation is in the posterior sections. Consolidated fragmentary fracture of the posterior edge of the tibia, with deformation of the posterior contour of the bone, without significant displacement of fragments. Paraarticular soft tissues are swollen.

Conclusion: CT picture of a three–ankle fracture of the right ankle joint. Spotted regional osteoporosis in the bones that form the right ankle joint, bones of the right foot (Zudek syndrome).

Ds: POP complicated by a pathological fracture. Vitamin D deficiency.

Treatment: Vigantol 15 drops daily – 6 weeks.

Teriparatide 20/ Rh– control 02.17.19. A consolidated fracture of the external ankle is determined. Bone callus is formed satisfactorily, post–traumatic bone deformation at this level is noted. Consolidated fracture of the medial ankle. Consolidated fracture of the posterior edge of the tibia.

02/19/19: P1NP 41.9, B–crosslaps– 1.158, 25 (OH) D 50.3, Ca, P – norm.

Conclusion: A clinical case demonstrates the acceleration of consolidation of a complex shin fracture with delayed consolidation during therapy with teriparatide.