Low-energy hip fracture in a socially withdrawn and physically inactive teenager highlighting the age-independent role of mechanical loading and nutrition: a case report.

backgroundProximal femur fractures in adolescents are rare and usually occur following high-energy trauma. When such injuries result from minimal trauma, they demand careful evaluation of skeletal integrity. This case highlights how social withdrawal, prolonged immobilization, and malnutrition can lead to reversible bone fragility and an unusual fracture pattern in a young patient. CASE PRESENTATION: A 14-year-old boy of Danish ethnicity with no prior somatic disease sustained an intertrochanteric femur fracture after falling from a floor bed of approximately one meter. For the preceding two years, he had been socially withdrawn and largely bedridden. Profound malnutrition, vitamin D deficiency, secondary hyperparathyroidism, and markedly reduced bone quality were evident. Intraoperative findings confirmed cortical thinning and brittle bone structure inconsistent with chronological age. The patient was treated with surgical fracture fixation using a pediatric dynamic hip screw in combination with vitamin D and calcium supplementation, calorie-dense nutrition, physiotherapy, and social support. The fracture healed, and over eight months he regained mobility, caught up on body weight and growth, and improved in developmental parameters.

conclusionsLow-energy hip fractures in adolescents are rare but may indicate reversible bone fragility from unloading and malnutrition; early multidisciplinary interventions are warranted.