Six long-term nursing home residents who experienced fractures of the long bones in the absence of obvious trauma are described. All patients had been essentially non-weight-bearing for at least 2 years before the episode. Four patients experienced fractures on more than one occasion. There was no evidence of physical abuse in any of these of patients; indeed, evidence against abuse was fairly good. Nonetheless, physical abuse was alleged by the patients' families in four of the cases. Long bone fracture in the absence of trauma in patients after prolonged bed rest has been well described in the radiologic and orthopedic literature, but not previously in geriatrics. It is important that this phenomenon be recognized, lest all unexplained fractures in nursing home patients automatically be taken as evidence of abuse or neglect.
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