Primary hyperparathyroidism (PHPT) is characterised by autonomous overproduction of parathyroid hormone (PTH), resulting in hypercalcemia and multisystem complications. Although routine calcium screening has reduced advanced skeletal disease in many regions, severe manifestations such as osteitis fibrosa cystica (OFC) still occur in resource-limited settings. We report a case of a woman in her 30s who presented with profound disability after 4-5 years of progressive bone pain, fatigue, proximal myopathy and eventual loss of independent ambulation, requiring her to drag herself on the ground. Imaging revealed generalised osteopenia, subperiosteal bone resorption, a 'salt and pepper' appearance of the skull, codfish vertebrae, anterior bowing of long bones and multiple lytic lesions consistent with advanced OFC. Laboratory investigations revealed marked hypercalcemia (14.3 mg/dL), hypophosphataemia (1.49 mg/dL), elevated alkaline phosphatase (781 U/L) and elevated intact PTH (iPTH) (1110 pg/mL), confirming PTH-dependent hypercalcemia. A 4D-CT scan localised a left inferior parathyroid adenoma (LIPA), and a renal ultrasound showed bilateral nephrocalcinosis. Following preoperative stabilisation with saline diuresis and intravenous zoledronic acid, she underwent minimally invasive parathyroidectomy (MIP) with an immediate postoperative fall in PTH, indicating biochemical cure. However, she developed hungry bone syndrome (HBS), requiring intensive intravenous and oral calcium supplementation along with active vitamin D therapy. This case highlights the catastrophic skeletal consequences of delayed PHPT diagnosis. It underscores the importance of early recognition of metabolic bone disease to prevent irreversible disability and systemic complications, particularly in low-resource settings.

Diffuse idiopathic skeletal hyperostosis (DISH) is characterized by extensive ossification of the spinal ligaments and entheses, resulting in a rigid spine that behaves biomechanically like a long bone. Although spinal fractures and dislocations after minor trauma are well recognized in ankylosed spines, non-traumatic spontaneous instability is rare. We report a rare case of spontaneous L4/L5 dislocation in a young patient with severe obesity and DISH. A 40-year-old man presented with progressive low back pain, bilateral lower extremity weakness, and bladder-bowel dysfunction. He had initially been treated at another hospital for septic shock due to urinary tract infection, but his neurological deficits persisted after improvement of the infection. On transfer to our institution, he was 168 cm tall, weighed 132 kg, and had a body mass index of 46.7 kg/m2. Neurological examination showed severe bilateral lower extremity weakness and sensory disturbance below the L1 level. Computed tomography demonstrated extensive thoracolumbar ankylosis consistent with DISH, with the L4/L5 segment representing the only remaining mobile level. An L5 superior articular process fracture, facet joint separation, and spontaneous L4/L5 dislocation were identified. Magnetic resonance imaging showed cauda equina compression at L4/L5. Because the lesion was considered highly unstable, staged circumferential reconstruction was performed. Initial percutaneous posterior fixation from L2 to S1 was carried out in the lateral decubitus position to avoid aggravation of the dislocation that might have occurred in the prone position. Pelvic fixation with S2 alar-iliac screws was then added in a second stage after repositioning the patient prone, because screw insertion was technically difficult in the lateral position. Anterior lumbar interbody fusion at L4/L5 with iliac bone grafting was subsequently performed. At six months postoperatively, low back pain had improved, and local stability was maintained, although severe motor deficits and bladder-bowel dysfunction persisted. In this patient, severe obesity and extensive ankylosis likely concentrated chronic mechanical stress at the L4/L5 segment, which functioned as the last mobile segment. This resulted in progressive failure culminating in spontaneous dislocation. Clinicians should recognize that, even without trauma, the last mobile segment in DISH may fail catastrophically. In such cases, rigid circumferential stabilization with long-segment fixation should be considered.

Background/Objectives: An Aneurysmal Bone Cyst (ABC) is a rare benign osteolytic bone lesion with locally destroying growth. It occurs mostly in the first two decades of life, rarely in older patients, and commonly affects the metaphysis. Clinical presentation includes pain and pathologic fractures. While most ABCs occur as primary lesions, there is an entity of secondary (reactive) ABC following osseous lesions such as fractures. We report a rare case of a secondary aneurysmal bone cyst of the distal radius following a distal radius fracture 4 years prior, with subsequent treatment and reconstruction. Methods: A 67-year-old female patient presented with a pathologic distal forearm fracture with radiologically expansive lytic bone lesion of the metaphysis of the distal radius, suspicious of an ABC. A biopsy and primary fracture management with an external fixator were performed due to the unclear dignity of the lesion. The diagnosis of an ABC was confirmed in the biopsy. The tumor resection and reconstruction were performed with a vascularized free fibula graft (ipsilateral, double barrel), using patient-specific 3D-printed osteotomy templates. Results: Follow-up radiographs showed excellent bone union with progressive remodeling. The functional outcome was very good with almost the same range of motion and grip strength as the contralateral side. No limitation in everyday life and no donor site morbidity was reported. Conclusions: ABC is a rare benign bone tumor the treatment of which consists of complete resection and reconstruction. Reconstruction of the distal radius can be achieved with a fibula graft. In our case, an excellent result was achieved with patient-specific osteotomy templates. Only a few cases of ABC in the distal radius and at this age have been reported; nevertheless, it should be considered as a differential diagnosis for osteolytic bone lesions.

We report the case of a 68-year-old male who sustained blunt chest trauma in a motor vehicle accident and presented with severe chest pain, dyspnea, pneumothorax, and multiple rib fractures. Imaging revealed a complete type I manubriosternal joint dislocation with an associated retrosternal hematoma. Urgent surgical intervention was planned; however, it was delayed for several hours because of inadequate fasting time. During this interval, the patient's anterior chest wall prominence subsided, and the patient's hemodynamic status improved. Follow-up chest computed tomography demonstrated complete spontaneous reduction of the manubriosternal joint dislocation. The patient was subsequently managed conservatively with analgesics, respiratory exercises, and close monitoring. He recovered without complications and remained stable on follow-up imaging 2 months later. This case highlights the rare occurrence of spontaneous reduction in traumatic manubriosternal joint dislocation.

Painful vertebral bone metastases may result in pathologic compression fractures, severe mechanical back pain, and functional impairment. Conventional external beam radiotherapy is commonly used for palliation but is limited by delayed analgesic effects and the inability to address spinal instability. Minimally invasive image-guided techniques, such as percutaneous radiofrequency ablation (RFA) combined with vertebral cement augmentation (VCA), may provide rapid pain relief while restoring mechanical stability. We report the case of a 66-year-old man with advanced lung cancer who presented with severe opioid-refractory low back pain. Magnetic resonance imaging demonstrated an acute L4 pathologic compression fracture with approximately 40% vertebral height loss and no evidence of spinal cord compression. The patient underwent a same-session image-guided percutaneous vertebral biopsy followed by RFA and balloon kyphoplasty. Pre-procedural pain severity was assessed using the Visual Analog Scale (VAS), with a score of 10/10. Within 24 hours after the intervention, the patient reported complete pain relief (VAS 0/10) and was able to ambulate independently, without procedural complications. This case highlights same-session percutaneous RFA combined with VCA as a minimally invasive strategy capable of providing rapid pain relief and immediate spinal stabilization in selected patients with painful vertebral metastases and pathologic compression fractures without spinal cord compression.

Pathological hip fractures are associated with substantial morbidity and functional decline. We report a rare case of localized dialysis-related amyloidosis involving both hip joints. A 48-year-old man undergoing long-term hemodialysis presented with atraumatic right hip pain. Radiographs and magnetic resonance imaging revealed a pathological subcapital fracture of the right femoral neck and extensive bilateral femoral neck osteolysis, with amyloid deposition showing low signal intensity on T1-weighted images and high signal intensity on T2-weighted images. Given the severe bone erosion and impending fracture of the left femoral neck, bilateral total hip arthroplasty was performed. No evidence of systemic amyloidosis or plasma cell dyscrasia was identified. At one-year follow-up, the patient showed no postoperative complications and regained independent ambulation. This case represents the first reported Korean case of localized dialysis-related amyloidosis affecting both hip joints.