Can you have a fracture without a fall?

Can You Have a Fracture Without a Fall?

Yes, fractures can occur without falls through multiple mechanisms including pathological bone disease, non-accidental trauma, spontaneous fractures from minimal activities, and vertebral compression fractures that occur during routine movements.

Pathological Fractures Without Trauma

Pathological fractures represent bone breaks that occur without adequate trauma due to underlying bone disease 1. These include:

• Osteoporosis-related fractures that can occur from minimal stress such as coughing, sneezing, or simply turning in bed 2, 1
• Vertebral compression fractures that may develop spontaneously during routine activities like bending forward or lifting light objects 2
• Osteogenesis imperfecta causing fragile bones that fracture with minimal or no identifiable trauma 2
• Metabolic bone diseases including osteomalacia, osteonecrosis, and Paget's disease that weaken bone structure 1
• Bone tumors or metastatic disease causing local bone destruction and spontaneous fractures 1

Fractures in Children Without Falls

In pediatric populations, fractures without falls are particularly concerning and require careful evaluation 2:

• Non-accidental trauma (child abuse) is a critical consideration, especially in non-ambulatory infants with long bone fractures 2
• Classic metaphyseal lesions have high specificity for abuse and may occur from shaking or twisting forces without a fall 2
• Rib fractures in infants under 24 months warrant skeletal survey regardless of reported history, as they rarely result from falls 2
• Femoral fractures in non-ambulatory children (under 9-11 months) are more likely from abuse than falls 2
• Fractures from stationary activities such as oblique distal femur fractures reported in children using activity centers like Exersaucers 2

Mechanisms of Non-Fall Fractures

Direct Impact Without Falling

• Being struck by objects or toys can cause fractures without the child or adult falling 2
• Motor vehicle accidents where the person remains seated but sustains fractures from impact forces 3

Torsional and Bending Forces

• Spiral fractures result from twisting forces along the bone's long axis, which can occur during activities like pivoting or being grabbed and twisted 2
• Transverse fractures from perpendicular bending loads that may occur during sports or physical activities without falling 2

Compression and Axial Loading

• Torus (buckle) fractures from axial compression, such as landing on feet from a jump without actually falling to the ground 2
• Vertebral compression fractures in osteoporotic patients from routine weight-bearing activities 2

Clinical Pitfalls and Red Flags

When History Doesn't Match Injury

A critical caveat is recognizing when fracture patterns are inconsistent with reported mechanisms 2:

• Fractures in non-ambulatory infants (0-11 months) with any long bone fracture except distal radius/ulna buckle fractures or toddler fractures in 9-11 month cruising infants require skeletal survey 2
• Multiple fractures or fractures of different ages suggest either bone fragility disorders or non-accidental trauma 2
• No history of trauma in a child with fracture mandates investigation for metabolic bone disease, osteogenesis imperfecta, or abuse 2

Distinguishing Pathological from Traumatic Fractures

• Pathological fractures require histological diagnosis to identify the underlying cause and ensure appropriate treatment 1
• Clinical and radiological detection is essential, as treatment differs fundamentally from traumatic fractures 1
• In osteoporotic adults, the energy required to fracture bone is often far less than the energy generated by a fall from standing height, meaning minimal trauma can cause fractures 4, 3

Age-Specific Considerations

Elderly Adults

• Spontaneous vertebral fractures are common in osteoporotic patients during routine activities 2
• Falls generate 10 times the energy needed to fracture the proximal femur, but fractures can occur from much less force in osteoporotic bone 3
• Fall history predicts fractures independently of bone density, particularly in those under 75 years old 5

Infants and Young Children

• Birth-related clavicle fractures can occur without postnatal trauma in neonates up to 10 days old 2
• Skeletal survey is necessary for all rib fractures in children 0-23 months regardless of history 2
• Bone fragility disorders must be considered in the differential diagnosis when fractures occur without adequate trauma 2