Fractures Without Falls

Pathological Fractures

Osteoporosis-related fractures can occur from minimal stress such as coughing or turning in bed, as recommended by the American College of Physicians, in patients with osteoporosis 1
Vertebral compression fractures may develop spontaneously during routine activities like bending forward or lifting light objects, according to the American College of Physicians, in patients with osteoporosis 1
Osteogenesis imperfecta causes fragile bones that fracture with minimal or no identifiable trauma, as stated by the American Academy of Pediatrics, in children with osteogenesis imperfecta 2, 3, 4

Non-accidental trauma is a critical consideration in non-ambulatory infants with long bone fractures, as recommended by the American Academy of Pediatrics, in cases of suspected child abuse 2, 5, 6
Classic metaphyseal lesions have high specificity for abuse and may occur from shaking or twisting forces without a fall, according to the American Academy of Pediatrics, in cases of suspected child abuse 2, 5
Rib fractures in infants under 24 months warrant skeletal survey regardless of reported history, as recommended by the American Academy of Pediatrics, in cases of suspected child abuse 7
Femoral fractures in non-ambulatory children are more likely from abuse than falls, according to the American Academy of Pediatrics, in cases of suspected child abuse 2, 4, 5

Spiral fractures result from twisting forces along the bone's long axis, which can occur during activities like pivoting or being grabbed and twisted, as described by the American Academy of Pediatrics, in children with spiral fractures 2, 4, 5, 6
Transverse fractures occur from perpendicular bending loads that may occur during sports or physical activities without falling, according to the American Academy of Pediatrics, in children with transverse fractures 2, 4, 5, 6
Vertebral compression fractures in osteoporotic patients can occur from routine weight-bearing activities, as recommended by the American College of Physicians, in patients with osteoporosis 1

Fractures in non-ambulatory infants with any long bone fracture except distal radius/ulna buckle fractures or toddler fractures in 9-11 month cruising infants require skeletal survey, as recommended by the American Academy of Pediatrics, in cases of suspected child abuse 7
Multiple fractures or fractures of different ages suggest either bone fragility disorders or non-accidental trauma, according to the American Academy of Pediatrics, in cases of suspected child abuse 2, 4, 6
No history of trauma in a child with fracture mandates investigation for metabolic bone disease, osteogenesis imperfecta, or abuse, as recommended by the American Academy of Pediatrics, in cases of suspected child abuse 2, 3, 4, 6

Spontaneous vertebral fractures are common in osteoporotic patients during routine activities, as recommended by the American College of Physicians, in patients with osteoporosis 1
Birth-related clavicle fractures can occur without postnatal trauma in neonates up to 10 days old, according to the American Academy of Pediatrics, in neonates with clavicle fractures 7
Skeletal survey is necessary for all rib fractures in children 0-23 months regardless of history, as recommended by the American Academy of Pediatrics, in cases of suspected child abuse 7
Bone fragility disorders must be considered in the differential diagnosis when fractures occur without adequate trauma, according to the American Academy of Pediatrics, in children with bone fragility disorders 2, 3, 4, 6