My name is Anirudh Reddy, and I'm a fourth year medical student at the University of Toledo College of Medicine and Life Sciences, and today we have a case report detailing rehabilitation fractures in hungry bone syndrome. Special acknowledgements be made to Dr. Stephen Farrell, the head of our PR and R department at the University of Toledo College of Medicine, Dr. Blake Kaley, and Dr. Megan Teeples, who are both resident physicians at the University of Toledo Physical Medicine Rehabilitation Residency. So, this clinical case report highlights a patient who experienced hungry bone syndrome that led to multiple fractures and specifically explores the acute rehabilitation course of this patient. Hungry bone syndrome is a unique consequence of parathyroidectomy and presents a significant surgical complication that physiatrists must understand. To speak of how common it is, in a study of 148 dialysis patients who underwent parathyroidectomy, 20% of the patients met the criteria for hungry bone syndrome. So, for the description of this case, we had a 34-year-old African American male who presented to the acute hospital after significant spasms from hypocalcemia during dialysis, the severe spasms caused by lateral intertrochanteric hip fractures, and a right-sided proximal humerus fracture. So, that's a quick summary of what we're about to go into. So, this patient had a history of hypertensive nephrosclerosis that led to ESRD, which is end-stage renal disease. This patient developed secondary and tertiary hyperparathyroidism due to this ESRD. This led to a surgical referral where the patient eventually had his parathyroid gland removed. After the procedure, the patient developed hungry bone syndrome. In hungry bone syndrome, after the body experiences a sudden drop in parathyroid hormone from the parathyroidectomy, the bones will resorb calcium from the bloodstream, leading to hypocalcemia. The hypocalcemia will lead to several severe muscle spasms, which in this patient caused a right humeral fracture and bilateral intertrochanteric hip fractures. It should also be noted that the patient previously had a left upper extremity previous osteoporotic fracture not related to this. So, this patient had an ORIF of the hip fractures and had his right humerus immobilized and treated conservatively. He then presented to the acute rehabilitation hospital for recovery. This patient was weight-bearing as tolerated in the lower extremities and the left upper extremity and non-weight-bearing on the right humerus. The reason we mentioned the weight-bearing precautions on the left upper extremity is because of that fracture we just spoke about. He was initially unable to perform physical therapy due to excess pain and needed an adjustment in his pain medication and total pain regimen. We were able to accomplish this through a multidisciplinary pain approach, including opiates, counseling, and spasm dampening with calcium control. After this, he was highly motivated and able to tolerate his therapy. He came to us initially maxed independent for all activities of daily living and mobility, and by discharge, he was sent mod I to CGA level and went to live only with his mother's assistance. At a one-month follow-up, the patient was doing well. He was 100% independent with ADLs and increasing ambulation without the use of a device. So for discussions and conclusions, the objective of this case report is to show the uniqueness of rehabilitating fractures in patients with end-stage renal disease complicated by hungry bone syndrome. This case highlights that multidisciplinary pain control and electrolyte correction are critical in these patients for proper rehabilitation. We've listed our references below, and my contact information is listed in the description here, so if you have any questions, please feel free to contact me. Thank you very much for your time, and have a nice day.

case report

hungry bone syndrome

parathyroidectomy

fractures

rehabilitation