CASE COMMUNICATIONS
IMAJ | volume 28
Journal 5, May 2026
pages: 320-323
A Tale of Three CTs: A Hip Fracture in a Patient with Down Syndrome Uncovers an Endocrinologic Iceberg
1 Department of Internal Medicine C, Sheba Medical Center, Tel Hashomer, Israel
2 Department of Orthopedic Surgery, Sheba Medical Center, Tel Hashomer, Israel
3 Diagnostic Imaging Department, Sheba Medical Center, Tel Hashomer, Israel
4 Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel
5 Division of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Tel Hashomer, Israel
6 Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
Summary
A 32-year-old man with Down syndrome (DS), nonverbal due to severe cognitive impairment, presented to the emergency department after sustaining a fall from standing, causing trauma to his left hip. He had no known chronic medication use. His previous medical history included hospitalizations for severe COVID-2019 in 2021 and herpes simplex virus stomatitis in 2017. Following the fall, he was unable to bear weight on the affected limb. On physical examination, his left leg was externally rotated with preserved neurovascular status. Given the mechanism of injury and clinical presentation, non-contrast computed tomography (NCCT) was obtained to assess fractures and underlying pathology [Figure 1A].