Disclosures: Hien-Khanh Huynh, MD: No financial relationships or conflicts of interest

Case Diagnosis: Bilateral Hip Fractures as Sequelae of Scorpion Sting Eight Years Earlier

Case Description: A 33 year old male veteran with a history of hemorrhagic necrotizing pancreatitis secondary to deathstalker (leiurus quinquestriatus) scorpion sting in Iraq eight years prior, leading to chronic pancreatitis with pancreatic insufficiency, end stage renal disease, and tertiary hyperparathyroidism . The patient presented to the outpatient musculoskeletal clinic for sudden increase of chronic left hip pain. Pain began 5 years prior after a traumatic dislocation. Previous computed tomography (CT) pelvis showed diffuse sclerosis of osseous structures. A new hip X-ray showed severe osseous demineralization, but no definite hip fracture. A follow up pelvic CT revealed complete pathologic fractures of bilateral femoral necks, as well as widespread lytic lesions in pelvis and proximal femurs compatible with severe renal osteodystrophy.

Setting: Outpatient musculoskeletal clinicAssessment/

Results: Patient was admitted. He had severe hyperkalemia and severely elevated parathyroid hormone. He underwent 3.5/4 parathyroidectomy with autotransplantation of 0.5 gland into the arm. Post op course was complicated by hungry bone syndrome. Patient underwent left hip arthroplasty and right hip hemiarthroplasty.

Discussion: This is the first reported case, to our knowledge, of hyperparathyroidism and hip fractures in the setting of chronic renal failure, as a long term consequence of scorpion sting. Chronic renal failure can then lead to a multitude of complications, including, as in this patient, renal osteodystrophy and secondary or tertiary hyperparathyroidism. This contributes to increased risk of fractures. The risk of fractures in people with glomerular filtration rate < 15 ml/min is about five times that of those with GFR > 60 ml/min. Hip fractures are four times more common in patients on dialysis than the general population.

Conclusion: Although scorpion stings are rare in North America, physicians should be aware of the possible serious long term complications from scorpion envenomations.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/bilateral-hip-fracture-as-a-sequela-of-scorpion-sting-eight-years-earlier-a-case-report/