Rohaiem Shaimaa N, Khan Basim F, Al-Julaih Ghadeer H, Mohammedin Ahmed S
Geriatrics and Gerontology, Ain Shams University, Cairo, EGY.
Pediatrics and Child Health, King Fahd Hospital of the University, Al-Khobar, SAU.
Cureus. 2023 Dec 30;15(12):e51333. doi: 10.7759/cureus.51333. eCollection 2023 Dec.
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.
非创伤性骨折（ATFs）是一种脆性骨折亚型，偶尔会引发法医学问题。ATFs被定义为因“通常被认为无法导致骨折的低能量机制”而引起的骨折。它们是一种报告不足的疾病，存在流行病学差异。ATF现象此前不仅在老年人中被报道，在儿童、年轻人和动物中也有报道。本研究是一个简短的回顾性病例系列，探讨了一所三级护理大学医院中的非创伤性骨折。在两年的时间里，共识别出7例ATF病例。然而，只有5例符合纳入标准。排除了病理性骨折的局部原因（如转移）以及虐待或忽视老年人的情况。对病例的临床特征、骨折特征和治疗进行了比较。所有5例均为体弱女性，因药物和多种疾病而承受着严重的骨毒性负担。ATF的表现包括典型症状（如疼痛）和非典型症状（如无痛、响亮的爆裂声和突然跌倒）。1例ATF伴有不明原因的无菌性发热。3例有不止一处骨折（骨折级联），通过X线进行确诊和随访。除1例行髋关节半关节置换术外，所有病例均采用保守治疗。护理计划包括处理骨毒性多种疾病负担，关注全身，而不仅仅是骨折或骨骼。该研究提供了有关ATF表现方面挑战的见解（如骨折急性期反应：成骨性无菌性发热）。传统上认为危险因素是骨质疏松症，但通常是全身性和多因素的。骨折预警信号的高风险可能有助于减少ATF的发生或骨折级联。检测到4种ATF类别，以帮助医疗系统识别高危患者，并提高医务人员、家庭和护理人员的认识。需要对高危人群进行进一步研究，以了解ATF的知识空白、挑战和最佳治疗方法。
