case_images: PMC10578970_01
case_images: Initial X-rays demonstrating a Delbert type III left-sided femoral neck fracture.
case_images: CRIOR2023-5550451.001.jpg
case_images: PMC10578970_01_CRIOR2023-5550451.001.jpg
case_images: fig1
case_images: She presented to an outside hospital where radiographs were consistent with a left femoral neck fracture. (Figure 1) The patient was then immediately transferred to a pediatric tertiary care center for definitive orthopaedic treatment.
case_images: Intraoperative fluoroscopy demonstrating closed reduction utilizing a traction table and placement of two 6.5 mm screws for fixation.
case_images: CRIOR2023-5550451.002.jpg
case_images: PMC10578970_01_CRIOR2023-5550451.002.jpg
case_images: fig2
case_images: Two 6.5 mm screws were used to compress and fix the fracture following anatomic reduction. (Figure 2) An anterior hip capsulotomy was also performed intraoperatively to relieve the expected high intracapsular pressure.
case_images: Mandibular X-rays on hospital day 2 displayed a lytic lesion with cortical breakthrough adjacent to the mandibular symphysis and a small area of erosion at the mandibular angle.
case_images: CRIOR2023-5550451.003.jpg
case_images: PMC10578970_01_CRIOR2023-5550451.003.jpg
case_images: fig3
case_images: Radiographs of the mandible were also taken and showed perimandibular lytic lesions (Figure 3).
case_images: Hematoxylin and eosin stain at 100x magnification of the resected parathyroid gland demonstrating a well-circumscribed with mass with eosinophili cells that exhibit large atypical nuclei with prominent nucleoli.
case_images: CRIOR2023-5550451.004.jpg
case_images: PMC10578970_01_CRIOR2023-5550451.004.jpg
case_images: fig4
case_images: Preliminary pathology revealed this was an atypical parafibromin-deficient parathyroid tumor (Figure 4).
case_images: Cyclin D1 staining of the resected parathyroid gland shows diffusely positive staining for cyclin D1.
case_images: CRIOR2023-5550451.005.jpg
case_images: PMC10578970_01_CRIOR2023-5550451.005.jpg
case_images: fig5
case_images: Further pathologic testing of the parathyroid mass revealed increased cyclin D1 expression (Figure 5), and genetic testing revealed that the patient had a CDC73/HRPT2 mutation.
case_images: X-rays taken at 5 months postop demonstrate healing of the femoral neck fracture in some varus with some shortening of the femoral neck.
case_images: CRIOR2023-5550451.006.jpg
case_images: PMC10578970_01_CRIOR2023-5550451.006.jpg
case_images: fig6
case_images: The patient was kept on crutches for 6 weeks and was not seen again until 5 months after surgery at which point she was full weight-bearing, without a limp, and had resumed all activities, including school gym (Figure 6).