A Rare Case of Neck of Femur Fracture in A Female Adolescent Associated With Minor Trauma and Impaired Bone Metabolism

This report describes a rare Neck of Femur (NOF) fracture in a 17-year-old female following a fall down two steps without preceding history of pain or medical disease. She had menarche at 14 with regular cycle however BMI was 15.82. Skin was covered for cultural reasons. Pelvic radiograph confirmed right NOF fracture. Given the low-impact injury and rarity of NOF fractures in this age, extensive blood investigations were performed post operatively. Vitamin D was 2 nmol/L (50-140), calcium 1.92 mmol/L (2.20-2.60), Parathyroid Hormone (PTH) 14.2 pmol/L (1.6-6.9), phosphate 1.06 mmol/L (0.80-1.50), ALP 380 IU/L (0-187). Others were normal. She was symptomatic of hypocalcaemia, with positive Chvostek’s sign. Impression Secondary Hyperparathyroidism (SHPT) due to vitamin D Deficiency (VDD) leading to NOF fracture. Fracture was repaired and a cholecalciferol course commenced. Following discharge, DEXA scan identified lumbar bone mineral density of T-score of -2.0, signifying osteopenia. Very few cases of NOF fracture in adolescents are reported. Those reported are associated with significant trauma or with known underlying medical conditions. In this rare case, NOF fracture in an adolescent patient without prior history, later found to have impaired bone metabolism is presented. Normal bone metabolism is complex and well documented. SHPT can lead to increased bone turnover, loss and increased fracture risk. Vitamin D is vital for bone health. Here is it stressed that VDD should not be overlooked as life altering complications can follow. Early identification and supplementation is recommended. Verbal consent has been obtained and there are no conflicts of interests.

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