title: Minimal trauma fractures: lifting the specter of misconduct by identifying risk factors and planning for prevention.
abstract: Minimal trauma fractures are an unfortunate, yet not uncommon, event for frail elderly individuals in long term care facilities. These fractures result in significant morbidity including pain and loss of function along with significantly increased mortality. Further concern exists for the medico-legal issues raised after a minimal trauma fracture is discovered. The controversy at hand is whether such fractures are primarily the result of inadequate, careless, or abusive care practices. We build a case to the contrary. Although the data regarding this condition are limited, there exists a reasonable evidence base to identify an at-risk patient population. We present a representative case and subsequent literature review of minimal trauma fractures to illustrate the condition, including risk factors, mode of presentation, and patient outcomes. No direct research has been conducted on the pathophysiology of these fractures. Extrapolating from other similar conditions and likely associated comorbid illnesses, we explore possible physiologic explanations for their occurrence. Again, no direct investigation into prevention or treatment of minimal trauma fractures has been published. Instead, we consider a variety of pharmacologic and nonpharmacologic interventions that may modify the risk for minimal trauma fractures considering the previously identified risk factors and probable pathophysiologic changes leading to fracture development. We propose that reducing minimal trauma fractures in the frail elderly nursing home population will require careful staff education, close attention to identify at-risk patients, and implementation of select interventions aimed at preventing such fractures.
authors.affiliation: Department of Internal Medicine, Division of Geriatrics, University of Texas Medical Branch, Galveston, TX, USA. erhommel@utmb.edu
authors.forename: Erin
authors.initials: E
authors.lastname: Hommel
authors.forename: Adline
authors.initials: A
authors.lastname: Ghazi
authors.forename: Heidi
authors.initials: H
authors.lastname: White
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control*; D000369:Aged, 80 and over; D003704:Dementia / Q000150:complications / Q000175:diagnosis*; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods*; D006620:Hip Fractures / Q000000981:diagnostic imaging / Q000517:prevention & control / Q000601:surgery; D006707:Homes for the Aged; D006801:Humans; D015601:Injury Severity Score; D011322:Primary Prevention / Q000379:methods*; D011859:Radiography; D018570:Risk Assessment; D012866:Skilled Nursing Facilities; D013781:Texas; D017749:Total Quality Management; D016896:Treatment Outcome