A Common Condition in an Uncommon Case: Spontaneous Hip Fracture on a Bedridden Elderly Woman

Andrade, Luiz Otávio Fernandes; Yepez-Kuri, J.; Francisco, Ana Paula; Smith, D.

doi:10.1093/geroni/igx004.4120

Cited by 1 publication

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“…Past reported cases included families suspecting iatrogenic abusive fractures (at hospitals or nursing homes) [ 5 , 18 , 23 ]. Home care-related ATFs (presenting to hospitals) were suspected of elder abuse or neglect (EAN) by healthcare providers [ 11 , 13 , 24 ]. Investigating these cases has excluded EAN by history and examination and could not find EAN evidence.…”

Section: Introductionmentioning

confidence: 99%

“…To facilitate discussion throughout this article, we are using the unified term "atraumatic fractures." ATF is a not uncommon phenomenon (maybe underreported) with epidemiological variations [13,14], with "most cases are reported as case series, with only a few epidemiological studies" [15]. Studies showed an incidence range from 1% to 15% [16].…”

Section: Introductionmentioning

confidence: 99%

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Atraumatic Fractures in Multi-Morbid Older Adults: A Series of Five Cases and Review of Literature

Rohaiem,

Khan,

Al-Julaih

et al. 2023

Cureus

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Atraumatic fractures (ATFs) are a fragility fracture subtype with occasional medicolegal issues. ATFs are defined as fractures because of a “low-energy mechanism that is usually considered incapable of producing a fracture.” They are an underreported disorder, with epidemiological variations. ATF phenomena were previously reported not only in older adults, but also in children, young adults, older adults, and animals. This study is a short retrospective case series exploring atraumatic fractures in a tertiary care university hospital. Over a period of two years, a total of seven ATF cases were identified. However, only five fulfilled the inclusion criteria. Local causes of pathologic fractures (e.g., metastasis) and elder abuse or neglect were excluded. Comparison of the cases’ clinical profile, fracture profile, and management was done. All five cases were frail females with significant osteotoxic burdens from medications and multi-morbidities. ATF presentations included typical (as pain) and atypical (as painless, loud crack, and sudden giveaway) symptomatology. One ATF had a coincident unexplained aseptic fever. Three cases had more than one fracture (fracture cascade), confirmed and followed up by x-rays. All the cases were managed conservatively except for one case that underwent hip hemiarthroplasty. Plans of care included managing the osteotoxic multi-morbidities burden, focusing on the whole body, not only on the fracture or bone. The study provided insights about challenges in presentations of ATF (as the bone fracture acute phase reaction: osteogenic aseptic fever). Risk factors are classically assumed to be osteoporosis, but it is usually systemic and multifactorial. A high risk of fracture warning sign could help decrease ATF occurrence or fracture cascades. Four ATF categories were detected to help healthcare systems identify high-risk patients and raise awareness among medical staff, families, and caregivers. Future studies of the at-risk groups are needed to understand ATF knowledge gaps, challenges, and the best treatments.

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