Hip fracture is one of the major causes of morbidity and mortality, 95 % are related to falls and 5 % are spontaneous. Spontaneous hip fractures are more common on the frail bedridden elderly individuals who reside in long term care facilities.We present a case of a 91 year-old female patient that who resides with her daughter. She had cerebral vascular accident that occurred three years ago which resulted on left sided hemiparesis with subsequent body contraction, deconditioning, and bed confinement. Patient developed an acute episode of pain on her left lower extremity for which she was transferred to the emergency department. An X-ray of the left femur revealed a closed left subtrochanteric femoral shaft fracture. The decision to repair the fracture was taken to ease the pain. Patient underwent procedure for open reduction, cephalomedullary nailing, left subtrochanteric femoral shaft fracture repair. Further studies reported evidence of osteopenia. Patient went home with no rehabilitation therapy.Spontaneous hip fractures in immobile patients are very rare, and when reported, more than 85% are intracapsular or trochanteric. Subtrochanteric femoral fracture in immobile elders accounts for less than 10% of the cases.In patients with a combination of lower limb contractures and osteoporotic bones, a simple twisting force or mild contusion is sufficient to cause fracture. Although we believe that our patient did not experienced physical abuse, unexplained fracture should also prompt physicians to investigate possible abuse. Identifying high-risk patients and providing meticulous nursing care, like methods for lifting and transferring patients, are paramount.
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